Provider Demographics
NPI:1942665211
Name:MOHAMMED ALI, MUSTAFA
Entity Type:Individual
Prefix:MR
First Name:MUSTAFA
Middle Name:
Last Name:MOHAMMED ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12254 E ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4318
Mailing Address - Country:US
Mailing Address - Phone:720-325-8694
Mailing Address - Fax:
Practice Address - Street 1:12254 E ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012
Practice Address - Country:US
Practice Address - Phone:720-325-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20151797380172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver