Healthcare Provider Details

I. General information

NPI: 1780413583
Provider Name (Legal Business Name): GARIKAI MOYO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 BUCKMAN SPRINGS RD
CAMPO CA
91906-2022
US

IV. Provider business mailing address

1777 BUCKMAN SPRINGS RD
CAMPO CA
91906-2022
US

V. Phone/Fax

Practice location:
  • Phone: 619-478-5696
  • Fax: 619-478-2404
Mailing address:
  • Phone: 619-478-5696
  • Fax: 619-478-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number689265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: