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General NPI Number Information
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NPI Number | 1700069127
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Entity Type | Individual
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Provider Name | DAVID MUGUKU M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 2750 ASTER ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8824
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Country | US
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Telephone | 337-480-8900
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Fax | 337-480-8901
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Provider Business Mailing Address
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Address Line | 2750 ASTER ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8824
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Country | US
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Telephone | 337-480-8900
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Fax | 337-480-8901
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AF2435609H63
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License Number State | DC
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