Individual
LATIF ADEYEMI MUSTAPHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
12025 W APACHE ST, AVONDALE, AZ 85323-8220
(623) 241-2084
Mailing address
12025 W APACHE ST, AVONDALE, AZ 85323-8220
(623) 241-2084
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
250957
AZ
Other
Enumeration date
12/25/2020
Last updated
12/25/2020
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