Provider Demographics
NPI:1144582966
Name:KURIAKOSE, MIMI MARELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:MARELLA
Last Name:KURIAKOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARELLA
Other - Middle Name:KURIAKOSE
Other - Last Name:HUDKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6070 S RAINBOW BLVD
Mailing Address - Street 2:UNIT 10
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2501
Mailing Address - Country:US
Mailing Address - Phone:702-420-7222
Mailing Address - Fax:702-331-6018
Practice Address - Street 1:6070 S RAINBOW BLVD
Practice Address - Street 2:UNIT 10
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2503
Practice Address - Country:US
Practice Address - Phone:702-420-7222
Practice Address - Fax:702-331-6018
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16076207PP0204X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program