Provider Demographics
NPI:1225678279
Name:MUTHUI, SIMON NJUGUNA
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:NJUGUNA
Last Name:MUTHUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 TALLOW TREE CIR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3515
Mailing Address - Country:US
Mailing Address - Phone:951-722-1739
Mailing Address - Fax:
Practice Address - Street 1:7930 TALLOW TREE CIR
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3515
Practice Address - Country:US
Practice Address - Phone:951-722-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245819164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse