Provider Demographics
NPI:1588189351
Name:MUTUKU, ELLINAH KALUMU (LVN)
Entity Type:Individual
Prefix:MS
First Name:ELLINAH
Middle Name:KALUMU
Last Name:MUTUKU
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27328 HONEY SCENTED RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4752
Mailing Address - Country:US
Mailing Address - Phone:951-443-5094
Mailing Address - Fax:
Practice Address - Street 1:27328 HONEY SCENTED RD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4752
Practice Address - Country:US
Practice Address - Phone:951-443-5094
Practice Address - Fax:951-443-5094
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-13
Last Update Date:2017-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206729164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty