Provider Demographics
NPI:1558199844
Name:MUSTAFA, IKRAM NAIF (RN,RBT)
Entity type:Individual
Prefix:
First Name:IKRAM
Middle Name:NAIF
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:RN,RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 NW 186TH ST APT 320
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3116
Mailing Address - Country:US
Mailing Address - Phone:954-398-3425
Mailing Address - Fax:
Practice Address - Street 1:7010 NW 186TH ST APT 320
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3116
Practice Address - Country:US
Practice Address - Phone:954-398-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-24-363780106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician