Provider Demographics
NPI:1568988780
Name:MWITI, FLORENCE KANYUA
Entity Type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:KANYUA
Last Name:MWITI
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 1:27622 CORTE DEL SOL
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5924
Mailing Address - Country:US
Mailing Address - Phone:951-214-8149
Mailing Address - Fax:
Practice Address - Street 1:27622 CORTE DEL SOL
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-5924
Practice Address - Country:US
Practice Address - Phone:951-214-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA204760164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty