Provider Demographics
NPI:1770269094
Name:KUKULA, EUREKA NGOIE
Entity type:Individual
Prefix:
First Name:EUREKA
Middle Name:NGOIE
Last Name:KUKULA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 REALM CT W
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1559
Mailing Address - Country:US
Mailing Address - Phone:213-461-3568
Mailing Address - Fax:
Practice Address - Street 1:2759 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2646
Practice Address - Country:US
Practice Address - Phone:202-563-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker