Healthcare Provider Details

I. General information

NPI: 1154217966
Provider Name (Legal Business Name): ELIZABETH WANJIKU MWAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14211 DRY CREEK ST
HESPERIA CA
92345-9107
US

IV. Provider business mailing address

14211 DRY CREEK ST
HESPERIA CA
92345-9107
US

V. Phone/Fax

Practice location:
  • Phone: 214-407-4395
  • Fax:
Mailing address:
  • Phone: 214-407-4395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95412664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: