Provider Demographics
NPI:1235537747
Name:NDIWENI, MGCINI ISRAEL I (RRT)
Entity Type:Individual
Prefix:
First Name:MGCINI
Middle Name:ISRAEL
Last Name:NDIWENI
Suffix:I
Gender:M
Credentials:RRT
Other - Prefix:MR
Other - First Name:ISRAEL
Other - Middle Name:MGCINI
Other - Last Name:MPOFU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:247 N 152ND DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2959
Mailing Address - Country:US
Mailing Address - Phone:480-498-0424
Mailing Address - Fax:
Practice Address - Street 1:247 N 152ND DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2959
Practice Address - Country:US
Practice Address - Phone:480-498-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ010922227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered