Provider Demographics
NPI:1386997930
Name:JARAVAZA, MUKAI HEATHER (MD)
Entity type:Individual
Prefix:DR
First Name:MUKAI
Middle Name:HEATHER
Last Name:JARAVAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MUKAI
Other - Middle Name:HEATHER
Other - Last Name:JARAVAZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2570 ROUTE 9W
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1323
Mailing Address - Country:US
Mailing Address - Phone:845-220-3100
Mailing Address - Fax:845-534-2940
Practice Address - Street 1:147 LAKE STREET
Practice Address - Street 2:GREATER HUDSON VALLEY FAMILY HEALTH CENT
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-563-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267143208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics