Healthcare Provider Details

I. General information

NPI: 1194569707
Provider Name (Legal Business Name): MICHAEL MONGA OWINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9358 LOST SPRINGS CT
ELK GROVE CA
95624-4800
US

IV. Provider business mailing address

9358 LOST SPRINGS CT
ELK GROVE CA
95624-4800
US

V. Phone/Fax

Practice location:
  • Phone: 916-247-4910
  • Fax:
Mailing address:
  • Phone: 916-247-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: