Latif Adeyemi Mustapha, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

250957 Issued in AZ

Practice address

12025 W Apache St
Avondale, AZ 85323-8220

Phone

(623) 241-2084

NPI assigned

Dec 25, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  AZ

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608854400000",
    "number": "1700473600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12025 W APACHE ST",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853238220",
            "telephone_number": "623-241-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12025 W APACHE ST",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853238220",
            "telephone_number": "623-241-2084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSTAPHA",
        "first_name": "LATIF",
        "middle_name": "ADEYEMI",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-25",
        "last_updated": "2020-12-25",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "250957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie A Munro
• Gabriel Murillo Nader, M.D.
• Alycia Murillo
• Latoya C Murphy, PMHNP-BC, DNP
• Lorne William Murray, MD
• My Dental L.L.C.
• Myeyedr Optometry of Washington, PLLC
• Sargon Nadirsha, PHARMD
• Koushik Nag, DO
• Govardhanan Nagaiah, MD

• Gerontology Nurse Practitioner in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Gerontology Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.