Healthcare Provider Details

I. General information

NPI: 1760324099
Provider Name (Legal Business Name): DJULIA SEKARIYONGO KOITA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 HYDE PARK AVE
HYDE PARK MA
02136-2819
US

IV. Provider business mailing address

14 BUSWELL ST APT 201
BOSTON MA
02215-2948
US

V. Phone/Fax

Practice location:
  • Phone: 888-763-7272
  • Fax: 877-243-2959
Mailing address:
  • Phone: 619-496-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: