Provider Demographics
NPI:1710360037
Name:MUOJIEJE, YVONNE MIRIAKU (DPM)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:MIRIAKU
Last Name:MUOJIEJE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 CAPISTRANO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7159
Mailing Address - Country:US
Mailing Address - Phone:763-516-4719
Mailing Address - Fax:
Practice Address - Street 1:4500 N SONOMA RANCH BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7334
Practice Address - Country:US
Practice Address - Phone:575-449-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006636213ES0103X
NMPOD429213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty