Provider Demographics
NPI:1023717063
Name:MAINA, CHARLES OLIVER WARUI
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:OLIVER WARUI
Last Name:MAINA
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 1:722 JOHNSON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1540
Mailing Address - Country:US
Mailing Address - Phone:510-374-9336
Mailing Address - Fax:
Practice Address - Street 1:722 JOHNSON ST APT 1
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1540
Practice Address - Country:US
Practice Address - Phone:510-374-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer