Provider Demographics
NPI:1346966900
Name:MUNGAI, SAMUEL (RN)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MUNGAI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 COROMAR CT
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-6130
Mailing Address - Country:US
Mailing Address - Phone:909-965-5270
Mailing Address - Fax:
Practice Address - Street 1:9055 COROMAR CT
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-6130
Practice Address - Country:US
Practice Address - Phone:909-965-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95275407163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse