Provider Demographics
NPI:1356984538
Name:MUSUNGU, ZILLAH JULIANA
Entity type:Individual
Prefix:
First Name:ZILLAH
Middle Name:JULIANA
Last Name:MUSUNGU
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 1:3443 S STATE ST STE 7
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-4915
Mailing Address - Country:US
Mailing Address - Phone:801-410-9493
Mailing Address - Fax:
Practice Address - Street 1:3443 S STATE ST STE 7
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-4915
Practice Address - Country:US
Practice Address - Phone:801-410-9493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11493820-1714332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies