Provider Demographics
NPI:1376813915
Name:FOZILOVA, MOKHIRA
Entity Type:Individual
Prefix:
First Name:MOKHIRA
Middle Name:
Last Name:FOZILOVA
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 1:2065 E 8TH ST
Mailing Address - Street 2:APT#A6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2065 E 8TH ST
Practice Address - Street 2:APT#A6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4144
Practice Address - Country:US
Practice Address - Phone:347-586-7426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse