Provider Demographics
NPI:1487713236
Name:MUSTAPHA, JUANITA SANDRA (HOME HEALTH AID)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:SANDRA
Last Name:MUSTAPHA
Suffix:
Gender:F
Credentials:HOME HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 FARRIS LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2306
Mailing Address - Country:US
Mailing Address - Phone:301-262-2976
Mailing Address - Fax:301-262-2976
Practice Address - Street 1:201 58TH ST NE
Practice Address - Street 2:APT. 003
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6800
Practice Address - Country:US
Practice Address - Phone:301-377-4821
Practice Address - Fax:301-262-2976
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide