Provider Demographics
NPI:1811563117
Name:MUSOKE, AMINAH NAMUDDU
Entity type:Individual
Prefix:
First Name:AMINAH
Middle Name:NAMUDDU
Last Name:MUSOKE
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 1:5609 AMAYA CT. APT 227
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3600
Mailing Address - Country:US
Mailing Address - Phone:781-990-9486
Mailing Address - Fax:
Practice Address - Street 1:27969 CALLE CASERA
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3054
Practice Address - Country:US
Practice Address - Phone:781-990-9486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1120431041C0700X
CA1015461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty