Healthcare Provider Details

I. General information

NPI: 1104263250
Provider Name (Legal Business Name): MISS SHEILA KONYU MUCHEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S. ARROYO PARKWAY PACIFIC CLINICS PASADENA FULL SERVICE PARTNERSH PROGRAM
PASADENA CA
91105-3970
US

IV. Provider business mailing address

262 N LOS ROBLES AVE APPT # 314
PASADENA CA
91101-1533
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-2794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: