Healthcare Provider Details

I. General information

NPI: 1609519768
Provider Name (Legal Business Name): RICHARD NZIOKA MUSINA REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 04/17/2022
Certification Date: 04/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 W LINCOLN AVE APT 106
ANAHEIM CA
92801-8200
US

IV. Provider business mailing address

2855 W LINCOLN AVE APT 106
ANAHEIM CA
92801-8200
US

V. Phone/Fax

Practice location:
  • Phone: 714-932-0576
  • Fax:
Mailing address:
  • Phone: 714-932-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95257430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: