Provider Demographics
NPI:1992731400
Name:SULEIMAN, MUSTAFA I (MD)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:I
Last Name:SULEIMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 694
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5908
Mailing Address - Country:US
Mailing Address - Phone:562-714-0607
Mailing Address - Fax:
Practice Address - Street 1:220 1ST STREET
Practice Address - Street 2:UNIT #2
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:562-714-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48051207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A480510OtherBLUE SHIELD
CA930063536OtherRAILROAD MEDICARE
CA00A480510Medicaid
CAWA48051FMedicare ID - Type Unspecified
CAE50614Medicare UPIN
CA00A480510OtherBLUE SHIELD