Provider Demographics
NPI:1922517762
Name:MUIRURI, MARYIMMACULATE
Entity Type:Individual
Prefix:
First Name:MARYIMMACULATE
Middle Name:
Last Name:MUIRURI
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 1:8892 MONTEREY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6348
Mailing Address - Country:US
Mailing Address - Phone:916-236-7339
Mailing Address - Fax:
Practice Address - Street 1:8892 MONTEREY OAKS DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6348
Practice Address - Country:US
Practice Address - Phone:916-236-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility