Provider Demographics
NPI:1780315309
Name:GABRIEL SAMA, KUSA
Entity type:Individual
Prefix:
First Name:KUSA
Middle Name:
Last Name:GABRIEL SAMA
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 1:630 S DAYTON ST # 311-7
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1306
Mailing Address - Country:US
Mailing Address - Phone:720-357-6294
Mailing Address - Fax:
Practice Address - Street 1:630 S DAYTON ST # 311-7
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1306
Practice Address - Country:US
Practice Address - Phone:720-357-6294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider