Provider Demographics
NPI:1639524382
Name:MWAURA, JUDY W
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:W
Last Name:MWAURA
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 1:13781 AMBERVIEW PL
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-5530
Mailing Address - Country:US
Mailing Address - Phone:310-795-5315
Mailing Address - Fax:
Practice Address - Street 1:13781 AMBERVIEW PL
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-5530
Practice Address - Country:US
Practice Address - Phone:310-795-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ269404363LP0808X
CA671633163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse