Provider Demographics
NPI:1376995332
Name:JONASON, MUMBI
Entity Type:Individual
Prefix:
First Name:MUMBI
Middle Name:
Last Name:JONASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16464 N 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1124
Mailing Address - Country:US
Mailing Address - Phone:623-293-6732
Mailing Address - Fax:
Practice Address - Street 1:16464 N 62ND AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1124
Practice Address - Country:US
Practice Address - Phone:623-293-6732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other