Provider Demographics
NPI:1487463972
Name:AL ANI, MUSTAFA
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:AL ANI
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 1:1500 1ST AVE NE STE 213
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4170
Mailing Address - Country:US
Mailing Address - Phone:507-601-2141
Mailing Address - Fax:
Practice Address - Street 1:1500 1ST AVE NE STE 213
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4170
Practice Address - Country:US
Practice Address - Phone:507-601-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN384530343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)