Healthcare Provider Details

I. General information

NPI: 1821551508
Provider Name (Legal Business Name): JOHN LANGALI MWAENGO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9455 FOULKS RANCH DR
ELK GROVE CA
95758-4320
US

IV. Provider business mailing address

9455 FOULKS RANCH DR
ELK GROVE CA
95758-4320
US

V. Phone/Fax

Practice location:
  • Phone: 951-322-9527
  • Fax:
Mailing address:
  • Phone: 951-322-9527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number290496
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT41074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: