Provider Demographics
NPI:1457999773
Name:NOOR, MUSTAFA SHARIF HASHIM
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:SHARIF HASHIM
Last Name:NOOR
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 1:3468 CITRUS ST STE I
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1503
Mailing Address - Country:US
Mailing Address - Phone:619-214-0085
Mailing Address - Fax:
Practice Address - Street 1:3468 CITRUS ST STE I
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1503
Practice Address - Country:US
Practice Address - Phone:619-214-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver