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General NPI Number Information
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NPI Number | 1154013415
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Entity Type | Individual
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Provider Name | JACKSON MWANGI MAINA
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Gender | Male
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 9568 MOSS HILL WAY
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City | SACRAMENTO
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State | CA
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Zip | 95829-9364
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Country | US
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Telephone | 206-375-7124
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Fax |
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Provider Business Mailing Address
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Address Line | 9568 MOSS HILL WAY
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City | SACRAMENTO
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State | CA
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Zip | 95829-9364
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Country | US
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Telephone | 206-375-7124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 732204
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License Number State | CA
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