Healthcare Provider Details

I. General information

NPI: 1871748640
Provider Name (Legal Business Name): CHRISTIAN MUSNGI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ENCINAL AVE
ALAMEDA CA
94501-4321
US

IV. Provider business mailing address

2101 ENCINAL AVE
ALAMEDA CA
94501-4321
US

V. Phone/Fax

Practice location:
  • Phone: 650-758-4700
  • Fax:
Mailing address:
  • Phone: 650-758-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: