Provider Demographics
NPI:1962119453
Name:MUSTIVA, DUKENS LOUISSAINT
Entity type:Individual
Prefix:MR
First Name:DUKENS
Middle Name:LOUISSAINT
Last Name:MUSTIVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LINTON BLVD STE 148A
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3336
Mailing Address - Country:US
Mailing Address - Phone:561-502-6443
Mailing Address - Fax:
Practice Address - Street 1:100 E LINTON BLVD STE 148A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3336
Practice Address - Country:US
Practice Address - Phone:561-502-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
FL238613376J00000X
FL237381376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver