Healthcare Provider Details

I. General information

NPI: 1538992599
Provider Name (Legal Business Name): MIRANDA KUKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 24TH ST NE
WASHINGTON DC
20018-2126
US

IV. Provider business mailing address

6837C RIVERDALE RD APT 201C
RIVERDALE MD
20737-1876
US

V. Phone/Fax

Practice location:
  • Phone: 408-348-5255
  • Fax:
Mailing address:
  • Phone: 240-927-9188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00209243
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: