Healthcare Provider Details

I. General information

NPI: 1659815520
Provider Name (Legal Business Name): LEONARD MUGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8117 HARFORD RD # 2
BALTIMORE MD
21234-5792
US

IV. Provider business mailing address

9936 VALGRANDE WAY
ELK GROVE CA
95757-3004
US

V. Phone/Fax

Practice location:
  • Phone: 410-900-4619
  • Fax: 531-200-7379
Mailing address:
  • Phone:
  • Fax: 531-200-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR181805
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR181805
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR181805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: