Provider Demographics
NPI:1689386401
Name:KALUNGI, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:KALUNGI
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 1:5526 W WALATOWA ST
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-5497
Mailing Address - Country:US
Mailing Address - Phone:702-521-7745
Mailing Address - Fax:
Practice Address - Street 1:2775 W PEBBLE RD UNIT 501
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-6564
Practice Address - Country:US
Practice Address - Phone:702-521-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness