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General NPI Number Information
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NPI Number | 1972701142
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Entity Type | Individual
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Provider Name | FRED WAITHAKA KIONI
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Gender | Male
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 4121 MARVIN D LOVE FWY SUITE 2000
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City | DALLAS
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State | TX
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Zip | 75224-4800
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Country | US
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Telephone | 972-709-7702
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Fax | 972-709-7708
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Provider Business Mailing Address
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Address Line | 13154 COIT RD SUITE 211
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City | DALLAS
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State | TX
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Zip | 75240-5773
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Country | US
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Telephone | 972-709-7702
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Fax | 972-709-7708
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 011187
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License Number State | TX
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