Provider Demographics
NPI:1790367399
Name:JOKOMBA, MUFTIAH
Entity Type:Individual
Prefix:
First Name:MUFTIAH
Middle Name:
Last Name:JOKOMBA
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 1:8938 WESTBRAE GARDENS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-3809
Mailing Address - Country:US
Mailing Address - Phone:832-709-7686
Mailing Address - Fax:
Practice Address - Street 1:1625 W OLYMPIC BLVD STE 790
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3809
Practice Address - Country:US
Practice Address - Phone:213-632-0256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CA300015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0009125681OtherMOLINA