Provider Demographics
NPI:1295132066
Name:HYMAS SAMKARA, OUSAPHEA (MSOM, LAC)
Entity type:Individual
Prefix:MS
First Name:OUSAPHEA
Middle Name:
Last Name:HYMAS SAMKARA
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 N 7TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7459
Mailing Address - Country:US
Mailing Address - Phone:970-250-2652
Mailing Address - Fax:
Practice Address - Street 1:2232 N 7TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7459
Practice Address - Country:US
Practice Address - Phone:970-250-2652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-22
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0001928171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist