Provider Demographics
NPI:1578239000
Name:MUIRU, GEORGE GATANA
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:GATANA
Last Name:MUIRU
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 1:1239 W BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6168
Mailing Address - Country:US
Mailing Address - Phone:314-354-0239
Mailing Address - Fax:
Practice Address - Street 1:1239 W BOSTON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6168
Practice Address - Country:US
Practice Address - Phone:314-354-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL1176IH376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator