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NPI Code Detail

MEDICARE: ALFIYA MITYUKOVA RN

MEDICARE: ALFIYA MITYUKOVA RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WI0500XInfusion Therapy Registered Nurse954645TX

General Provider Information

NPI Number : 1750117032
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALFIYA MITYUKOVA RN
Provider Business Mailing Address
First Line : 7400 MERTON MINTER ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-4404
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7400 MERTON MINTER ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-4404
Country : US
Telephone Number : 210-617-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2024
Last Update Date : 09/12/2024

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