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NPI Code Detail

MEDICARE: SIMON GITONGA

MEDICARE: SIMON GITONGA
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 TechnicianWA

General Provider Information

NPI Number : 1811820202
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMON GITONGA
Provider Business Mailing Address
First Line : 12104 172ND STREET CT E
Second Line :
City : PUYALLUP
State : WA
Zip : 98374-4509
Country : US
Telephone Number : 253-440-1438
Fax Number : 253-364-1918
Provider Business Practice Location Address
First Line : 12104 172ND STREET CT E
Second Line :
City : PUYALLUP
State : WA
Zip : 98374-4509
Country : US
Telephone Number : 253-440-1438
Fax Number : 253-364-1918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2026
Last Update Date : 06/04/2026

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Directions to “ SIMON GITONGA ” Practice Location

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