Provider Demographics
NPI:1023483781
Name:MWAURA, JUDAH
Entity type:Individual
Prefix:
First Name:JUDAH
Middle Name:
Last Name:MWAURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11685 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2737
Mailing Address - Country:US
Mailing Address - Phone:951-703-9023
Mailing Address - Fax:
Practice Address - Street 1:11685 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-2737
Practice Address - Country:US
Practice Address - Phone:951-703-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN226728164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse