Provider Demographics
NPI:1205480019
Name:POUX, KIIRA NOELLE
Entity type:Individual
Prefix:
First Name:KIIRA
Middle Name:NOELLE
Last Name:POUX
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 1:4633 APPLEGLEN ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-4779
Mailing Address - Country:US
Mailing Address - Phone:404-723-2104
Mailing Address - Fax:
Practice Address - Street 1:202 GLACIER DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4826
Practice Address - Country:US
Practice Address - Phone:404-723-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program