Provider Demographics
NPI:1679936439
Name:ALWASH, MUSTAFA ADAM (MD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:ADAM
Last Name:ALWASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUSTAFA
Other - Middle Name:A
Other - Last Name:SAUDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8765 AERO DR STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1767
Mailing Address - Country:US
Mailing Address - Phone:832-929-2237
Mailing Address - Fax:
Practice Address - Street 1:7901 FROST ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2701
Practice Address - Country:US
Practice Address - Phone:858-541-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160516208M00000X, 208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program