Healthcare Provider Details

I. General information

NPI: 1013554237
Provider Name (Legal Business Name): SOFIA KAFULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6856 EASTERN AVE NW
WASHINGTON DC
20012-2165
US

IV. Provider business mailing address

6856 EASTERN AVE NW STE 320A
WASHINGTON DC
20012-2112
US

V. Phone/Fax

Practice location:
  • Phone: 202-541-9845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN1053910
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: