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Mina Mostafavifar

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

PECOS Enrollment

Based on the most recent information from CMS, provider Mina Mostafavifar is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1639551468
Provider Type
Individual
Full Name
Mostafavifar, Mina
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
6/29/2015
Last Updated
12/18/2020

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 494-8311

Unlisted Fax

Mailing Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 494-8311

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA202153 Oregon
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA202153 Oregon
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA2015-0039 New Mexico

Mina Mostafavifar

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Friberg, Whitni Nicole

Skolnik, Kevin

Melean, Cynthia Elizabeth

Anderson, Molly

Newhart, Bradley Thomas

Bernstein, Juliana Mogielnicki

Atwood, Ashley

Egan, Lisa Anne

Shears, Gayle Lauren

Myers, Robert A