MEDICARE: TITUS WAITITU NJUGUNA CERTIFIED CAREGIVER,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider	AZ12788	AZ

General Provider Information

NPI Number	:	1801565544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TITUS WAITITU NJUGUNA CERTIFIED CAREGIVER,

Provider Business Mailing Address
First Line	:	2010 W BRANHAM LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-7718
Country	:	US
Telephone Number	:	469-254-3912
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 W BRANHAM LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-7718
Country	:	US
Telephone Number	:	469-254-3912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	09/07/2021

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