Provider Demographics
NPI:1275017881
Name:NGANGA, DICKSON
Entity Type:Individual
Prefix:
First Name:DICKSON
Middle Name:
Last Name:NGANGA
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 1:3031 N 64TH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-0925
Mailing Address - Country:US
Mailing Address - Phone:623-759-9177
Mailing Address - Fax:480-504-2102
Practice Address - Street 1:3031 N 64TH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-0925
Practice Address - Country:US
Practice Address - Phone:623-759-9177
Practice Address - Fax:480-504-2102
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide