Provider Demographics
NPI:1457184657
Name:MULLOKANDOVA, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MULLOKANDOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6838 YELLOWSTONE BLVD APT B35
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3425
Mailing Address - Country:US
Mailing Address - Phone:646-784-8707
Mailing Address - Fax:
Practice Address - Street 1:6838 YELLOWSTONE BLVD APT B35
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3425
Practice Address - Country:US
Practice Address - Phone:646-784-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty