Provider Demographics
NPI:1346859428
Name:MUTITU, RUFUS
Entity Type:Individual
Prefix:MR
First Name:RUFUS
Middle Name:
Last Name:MUTITU
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 1:6401 KENMORE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1192
Mailing Address - Country:US
Mailing Address - Phone:915-261-6886
Mailing Address - Fax:
Practice Address - Street 1:6401 KENMORE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1192
Practice Address - Country:US
Practice Address - Phone:915-261-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800846163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty