MEDICARE: MR. MWEZO KUDUMU BS, CERT. OF NURSING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225700000X	Massage Therapist
2	3747A0650X	Attendant Care Provider
3	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1568626679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MWEZO KUDUMU BS, CERT. OF NURSING

Provider Business Mailing Address
First Line	:	4848 SAN FELIPE RD
Second Line	:	301
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1276
Country	:	US
Telephone Number	:	408-315-1179
Fax Number	:	408-279-2955

Provider Business Practice Location Address
First Line	:	4848 SAN FELIPE RD
Second Line	:	301
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1276
Country	:	US
Telephone Number	:	408-315-1179
Fax Number	:	408-279-2955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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