Healthcare Provider Details

I. General information

NPI: 1568626679
Provider Name (Legal Business Name): MWEZO KUDUMU BS, CERT. OF NURSING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 SAN FELIPE RD 301
SAN JOSE CA
95135-1276
US

IV. Provider business mailing address

4848 SAN FELIPE RD 301
SAN JOSE CA
95135-1276
US

V. Phone/Fax

Practice location:
  • Phone: 408-315-1179
  • Fax: 408-279-2955
Mailing address:
  • Phone: 408-315-1179
  • Fax: 408-279-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: