Provider Demographics
NPI:1366184566
Name:MWANGI, PAUL KARENGA
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:KARENGA
Last Name:MWANGI
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 1:27816 WHITTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7890
Mailing Address - Country:US
Mailing Address - Phone:909-800-9598
Mailing Address - Fax:
Practice Address - Street 1:27816 WHITTINGTON RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7890
Practice Address - Country:US
Practice Address - Phone:909-800-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA721684164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse