Provider Demographics
NPI:1366135170
Name:NGU MAPOH, AZENWIE
Entity type:Individual
Prefix:
First Name:AZENWIE
Middle Name:
Last Name:NGU MAPOH
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 1:4435 N LONGVIEW AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-6055
Mailing Address - Country:US
Mailing Address - Phone:520-585-2023
Mailing Address - Fax:
Practice Address - Street 1:4435 N LONGVIEW AVE APT 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-6055
Practice Address - Country:US
Practice Address - Phone:520-585-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)