Provider Demographics
NPI:1821464827
Name:KIYAYA MENAYAME, GUYGUY
Entity Type:Individual
Prefix:
First Name:GUYGUY
Middle Name:
Last Name:KIYAYA MENAYAME
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 1:500 EVERGREEN ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-7229
Mailing Address - Country:US
Mailing Address - Phone:323-671-9926
Mailing Address - Fax:424-331-5884
Practice Address - Street 1:500 EVERGREEN ST UNIT 103
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-7229
Practice Address - Country:US
Practice Address - Phone:323-671-9926
Practice Address - Fax:424-331-5884
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00846470376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide