Provider Demographics
NPI:1861434458
Name:MUSTAPHA, RAIFU F
Entity type:Individual
Prefix:
First Name:RAIFU
Middle Name:F
Last Name:MUSTAPHA
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 1:1111 W ARKANSAS LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6376
Mailing Address - Country:US
Mailing Address - Phone:817-784-9454
Mailing Address - Fax:817-467-7055
Practice Address - Street 1:1111 W ARKANSAS LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6376
Practice Address - Country:US
Practice Address - Phone:817-784-9454
Practice Address - Fax:817-467-7055
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631560163WH0200X
TX196491164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679209Medicare Oscar/Certification