MEDICARE: MRS. MILALUZ TUBA AFUANG RN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	404971-1	NY

General Provider Information

NPI Number	:	1578102380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MILALUZ TUBA AFUANG RN

Provider Business Mailing Address
First Line	:	KIRBY FORENSIC PSCHIATRIC CENTER
Second Line	:	600 E 125TH STREET
City	:	NEW YORK
State	:	NY
Zip	:	10035-6095
Country	:	US
Telephone Number	:	646-672-6805
Fax Number	:	646-672-6898

Provider Business Practice Location Address
First Line	:	KIRBY FORENSIC PSCHIATRIC CENTER
Second Line	:	600 E 125TH STREET
City	:	NEW YORK
State	:	NY
Zip	:	10035-6095
Country	:	US
Telephone Number	:	646-672-6805
Fax Number	:	646-672-6898

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

Provider Enumeration Date	:	12/26/2019
Last Update Date	:	12/26/2019

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