MEDICARE: KATHLEEN WAIRIMU MD PC

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	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760581532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHLEEN WAIRIMU MD PC

Provider Business Mailing Address
First Line	:	PO BOX 34686
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-4686
Country	:	US
Telephone Number	:
Fax Number	:	702-492-1728

Provider Business Practice Location Address
First Line	:	3416 N BUFFALO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7424
Country	:	US
Telephone Number	:	702-666-3388
Fax Number	:

Authorized Official
Title or Position	:	AO
Name	:	ALYONA BEAUCHAMP
Credential	:
Telephone Number	:	702-407-8241

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	10/08/2018

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