Healthcare Provider Details

I. General information

NPI: 1932036548
Provider Name (Legal Business Name): SAMAHIR MUTWALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1578 E MEGAN ST
CHANDLER AZ
85225-9008
US

IV. Provider business mailing address

1578 E MEGAN ST
CHANDLER AZ
85225-9008
US

V. Phone/Fax

Practice location:
  • Phone: 480-765-8270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number09557414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: