Provider Demographics
NPI:1588143630
Name:MUKASA, VICTOR L (CP)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:L
Last Name:MUKASA
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18824 BENT WILLOW CIR APT 324
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-7323
Mailing Address - Country:US
Mailing Address - Phone:202-431-2602
Mailing Address - Fax:
Practice Address - Street 1:13000 HARBOR CENTER DR STE 312
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2847
Practice Address - Country:US
Practice Address - Phone:202-431-2602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide