Provider Demographics
NPI:1619675220
Name:AGIL, MUSTAFA
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:AGIL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MUSTAFA
Other - Middle Name:
Other - Last Name:AGIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MUSTAFA AGIL
Mailing Address - Street 1:18612 N 4TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18612 N 4TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5670
Practice Address - Country:US
Practice Address - Phone:602-301-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)