Provider Demographics
NPI:1427563535
Name:MADIYE, KUMBIRAI (PMHNP)
Entity Type:Individual
Prefix:
First Name:KUMBIRAI
Middle Name:
Last Name:MADIYE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 S COAST HWY # 4560
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3681
Mailing Address - Country:US
Mailing Address - Phone:425-615-4312
Mailing Address - Fax:442-253-8085
Practice Address - Street 1:MINDWORKS CONNECTION
Practice Address - Street 2:1968 S COAST HWY # 4560
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-3681
Practice Address - Country:US
Practice Address - Phone:425-615-4312
Practice Address - Fax:442-253-8085
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61108955363LP0808X
AZ228169363LP0808X
CA95008989363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health