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NPI Code Detail

MEDICARE: GRACE WAMAITHA NDUNGU

MEDICARE: GRACE WAMAITHA NDUNGU
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1649811993
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE WAMAITHA NDUNGU
Provider Business Mailing Address
First Line : 1055 E COLORADO BLVD STE 560
Second Line :
City : PASADENA
State : CA
Zip : 91106-2380
Country : US
Telephone Number : 818-241-6780
Fax Number : 818-241-6853
Provider Business Practice Location Address
First Line : 6 LINCOLN KNOLL LN
Second Line :
City : BURLINGTON
State : MA
Zip : 01803-4725
Country : US
Telephone Number : 855-646-8247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2019
Last Update Date : 10/07/2019

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Directions to “ GRACE WAMAITHA NDUNGU ” Practice Location

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