Provider Demographics
NPI:1508468554
Name:MWAMBIA, SILAS MITHIKA
Entity Type:Individual
Prefix:
First Name:SILAS
Middle Name:MITHIKA
Last Name:MWAMBIA
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 1:5508 VICKSBURG DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4984
Mailing Address - Country:US
Mailing Address - Phone:817-704-9197
Mailing Address - Fax:
Practice Address - Street 1:5508 VICKSBURG DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-4984
Practice Address - Country:US
Practice Address - Phone:817-704-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily