Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD-001004 | AZ |
Y | 222Z00000X | Podiatrist | POD-001004 | AZ |
NPI | 1073002168 |
---|---|
Provider Name | Dylan Kaumaya |
First Address | Peoria, AZ 85381-4836 |
Second Address | Peoria, AZ 85381-4836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2018 |
Last Update Date | 04/11/2021 |