Healthcare Provider Details

I. General information

NPI: 1235267006
Provider Name (Legal Business Name): MUMBI NGUNJIRI KAIRU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 N FAIR OAKS AVE SUITE 2600
PASADENA CA
91103-1620
US

IV. Provider business mailing address

13215 SUNBIRD DR
MORENO VALLEY CA
92553-5649
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone: 909-702-5650
  • Fax: 714-551-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number16570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: