Provider Demographics
NPI:1881120913
Name:MONIS, MUSTAFA (PA)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:MONIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8522 BROADWAY STE 216
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6456
Mailing Address - Country:US
Mailing Address - Phone:210-874-5260
Mailing Address - Fax:210-864-4838
Practice Address - Street 1:5939 BABCOCK RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2199
Practice Address - Country:US
Practice Address - Phone:210-874-5260
Practice Address - Fax:210-864-4838
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA11292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant