Basic Information
| Provider Information | |||||||||
| NPI: | 1750624920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBUSTANI | ||||||||
| FirstName: | MUSTAFA | ||||||||
| MiddleName: | QAYS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 232410 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921932410 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2625 W ALAMEDA AVE STE 322 | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915054822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188439015 | ||||||||
| FaxNumber: | 8188439016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2013 | ||||||||
| LastUpdateDate: | 12/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A153289 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | A153289 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.