Provider Demographics
NPI:1902634264
Name:MOKUA, NAOMI KIYONDI
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:KIYONDI
Last Name:MOKUA
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 1:6204 MAYFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2371
Mailing Address - Country:US
Mailing Address - Phone:713-498-4883
Mailing Address - Fax:
Practice Address - Street 1:6204 MAYFIELD AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2371
Practice Address - Country:US
Practice Address - Phone:713-498-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95388589163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty