Individual
KHALID MUSTAFA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12 SOUTHERN AVE, BOSTON, MA 02124-2012
(617) 780-0870
(617) 516-8274
Mailing address
12 SOUTHERN AVE, BOSTON, MA 02124-2012
(617) 708-0870
(617) 516-8274
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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