Healthcare Provider Details

I. General information

NPI: 1659841625
Provider Name (Legal Business Name): CHARLES NJIRIRI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ESTRADA PKWY APT 1004
IRVING TX
75061-8282
US

IV. Provider business mailing address

1800 ESTRADA PKWY APT 1004
IRVING TX
75061-8282
US

V. Phone/Fax

Practice location:
  • Phone: 817-808-4836
  • Fax:
Mailing address:
  • Phone: 817-808-4836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number322731
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: