Provider Demographics
NPI:1184447096
Name:MASTAN-OLIVERA, MOZMIN NISHA
Entity type:Individual
Prefix:DR
First Name:MOZMIN
Middle Name:NISHA
Last Name:MASTAN-OLIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MOZMIN
Other - Middle Name:NISHA
Other - Last Name:MASTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8945 GOLF LINKS RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4124
Mailing Address - Country:US
Mailing Address - Phone:510-317-1444
Mailing Address - Fax:
Practice Address - Street 1:8945 GOLF LINKS RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4124
Practice Address - Country:US
Practice Address - Phone:510-317-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker