Provider Demographics
NPI:1033896451
Name:IRUNGU, DISMUS WAWERU (FNP-C)
Entity Type:Individual
Prefix:
First Name:DISMUS
Middle Name:WAWERU
Last Name:IRUNGU
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 N EDGEMONT ST APT 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5220
Mailing Address - Country:US
Mailing Address - Phone:213-545-4385
Mailing Address - Fax:
Practice Address - Street 1:4550 PANAMA LN STE 100-200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-3436
Practice Address - Country:US
Practice Address - Phone:661-631-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025677363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care