Provider Demographics
NPI:1174812929
Name:MOUSTAFA, ROCIO A (MD)
Entity type:Individual
Prefix:DR
First Name:ROCIO
Middle Name:A
Last Name:MOUSTAFA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROCIO
Other - Middle Name:
Other - Last Name:AGUSTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3291 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3099
Mailing Address - Country:US
Mailing Address - Phone:805-652-6556
Mailing Address - Fax:
Practice Address - Street 1:3291 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3099
Practice Address - Country:US
Practice Address - Phone:805-652-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-06-12
Deactivation Date:2011-03-02
Deactivation Code:
Reactivation Date:2011-03-25
Provider Licenses
StateLicense IDTaxonomies
CAA507372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF27918Medicare UPIN