Healthcare Provider Details

I. General information

NPI: 1386430650
Provider Name (Legal Business Name): IRENE M KINUTHIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E RAY RD STE 130
GILBERT AZ
85296-4206
US

IV. Provider business mailing address

633 E RAY RD STE 130
GILBERT AZ
85296-4206
US

V. Phone/Fax

Practice location:
  • Phone: 480-812-3680
  • Fax:
Mailing address:
  • Phone: 480-812-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number308303
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: