Provider Demographics
NPI:1659690501
Name:MUSTAFA, REHANA Y (RPH)
Entity Type:Individual
Prefix:MRS
First Name:REHANA
Middle Name:Y
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 LOPEZ ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881
Mailing Address - Country:US
Mailing Address - Phone:951-735-3143
Mailing Address - Fax:
Practice Address - Street 1:1292 BORDER AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882
Practice Address - Country:US
Practice Address - Phone:951-735-1011
Practice Address - Fax:951-735-1130
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41272OtherLICENCE