Healthcare Provider Details

I. General information

NPI: 1477075240
Provider Name (Legal Business Name): MUNA MOHAMED KULMIYE RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/08/2025
Certification Date: 07/07/2025
Deactivation Date: 02/04/2022
Reactivation Date: 03/17/2022

III. Provider practice location address

200 OCEANGATE STE 100
LONG BEACH CA
90802-4317
US

IV. Provider business mailing address

200 OCEANGATE STE 100
LONG BEACH CA
90802-4317
US

V. Phone/Fax

Practice location:
  • Phone: 612-702-6182
  • Fax:
Mailing address:
  • Phone: 612-702-6182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024939
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR187149-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: