Healthcare Provider Details

I. General information

NPI: 1326575101
Provider Name (Legal Business Name): KYMISHA PINA S.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

7872 AMERICANA CIR APT 202
GLEN BURNIE MD
21060-5433
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4080
  • Fax:
Mailing address:
  • Phone: 774-271-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number16-759
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: