Individual
MOHAMMED MUSTAPHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2438 19TH AVE NW, ROCHESTER, MN 55901-7616
(507) 244-1724
Mailing address
2438 19TH AVE NW, ROCHESTER, MN 55901-7616
(507) 244-1724
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/06/2015
Last updated
10/06/2015
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