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General NPI Number Information
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NPI Number | 1588143630
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Entity Type | Individual
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Provider Name | VICTOR L MUKASA CP
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Gender | Male
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 13000 HARBOR CENTER DR STE 312
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2847
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Country | US
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Telephone | 202-431-2602
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Fax |
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Provider Business Mailing Address
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Address Line | 18824 BENT WILLOW CIR APT 324
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City | GERMANTOWN
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State | MD
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Zip | 20874-7323
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Country | US
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Telephone | 202-431-2602
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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