Healthcare Provider Details

I. General information

NPI: 1598320996
Provider Name (Legal Business Name): WAIRIMU R. MWAURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 400
LA JOLLA CA
92037-1212
US

IV. Provider business mailing address

3075 HEALTH CENTER DR STE 102
SAN DIEGO CA
92123-2773
US

V. Phone/Fax

Practice location:
  • Phone: 858-558-8666
  • Fax: 858-558-9233
Mailing address:
  • Phone: 858-637-7888
  • Fax: 858-637-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: