Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 16076 | NV |
N | 208000000X | Pediatrician | 16076 | NV |
NPI | 1144582966 |
---|---|
Provider Name | Dr. Mimi Marella Kuriakose |
First Address | Las Vegas, NV 89102-2207 |
Second Address | Las Vegas, NV 89102-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2012 |
Last Update Date | 05/04/2018 |