Provider Demographics
NPI:1467795203
Name:KUVHENGUHWA, MAITA SITI (MD)
Entity Type:Individual
Prefix:
First Name:MAITA
Middle Name:SITI
Last Name:KUVHENGUHWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 W ROSECRANS AVE STE 18-21
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-3858
Mailing Address - Country:US
Mailing Address - Phone:424-529-6755
Mailing Address - Fax:424-296-3953
Practice Address - Street 1:2251 W ROSECRANS AVE STE 18-21
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222
Practice Address - Country:US
Practice Address - Phone:424-529-6755
Practice Address - Fax:424-296-3953
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132619207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty