Healthcare Provider Details

I. General information

NPI: 1043730963
Provider Name (Legal Business Name): PIUS JOHN MBATIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E WASHINGTON ST STE 207
PETALUMA CA
94952-5912
US

IV. Provider business mailing address

620 E WASHINGTON ST STE 207
PETALUMA CA
94952-5912
US

V. Phone/Fax

Practice location:
  • Phone: 707-971-7125
  • Fax:
Mailing address:
  • Phone: 707-971-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JOSEPHINE M KIMANI
Title or Position: C.E.O
Credential:
Phone: 707-971-1263