Provider Demographics
NPI:1568626679
Name:KUDUMU, MWEZO (BS, CERT OF NURSING)
Entity Type:Individual
Prefix:MR
First Name:MWEZO
Middle Name:
Last Name:KUDUMU
Suffix:
Gender:M
Credentials:BS, CERT OF NURSING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 SAN FELIPE RD
Mailing Address - Street 2:301
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1276
Mailing Address - Country:US
Mailing Address - Phone:408-315-1179
Mailing Address - Fax:408-279-2955
Practice Address - Street 1:4848 SAN FELIPE RD
Practice Address - Street 2:301
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1276
Practice Address - Country:US
Practice Address - Phone:408-315-1179
Practice Address - Fax:408-279-2955
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider