Provider Demographics
NPI:1013466515
Name:MUSTELIER, AILEN O
Entity Type:Individual
Prefix:
First Name:AILEN
Middle Name:O
Last Name:MUSTELIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10940 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3406
Mailing Address - Country:US
Mailing Address - Phone:786-518-7031
Mailing Address - Fax:
Practice Address - Street 1:10940 NW 21ST ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3406
Practice Address - Country:US
Practice Address - Phone:786-518-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-15-05442OtherRBT