MEDICARE: MR. GEORGE GATANA MUIRU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376G00000X	Nursing Home Administrator	AL1176IH	AZ

General Provider Information

NPI Number	:	1578239000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE GATANA MUIRU

Provider Business Mailing Address
First Line	:	1239 W BOSTON ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6168
Country	:	US
Telephone Number	:	314-354-0239
Fax Number	:

Provider Business Practice Location Address
First Line	:	1239 W BOSTON ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6168
Country	:	US
Telephone Number	:	314-354-0239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	08/16/2021

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