Provider Demographics
NPI:1134592108
Name:MUNGAI, PERIS
Entity type:Individual
Prefix:
First Name:PERIS
Middle Name:
Last Name:MUNGAI
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 1:11922 NYANZA RD SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1438
Mailing Address - Country:US
Mailing Address - Phone:253-503-0459
Mailing Address - Fax:253-301-1576
Practice Address - Street 1:11922 NYANZA RD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1438
Practice Address - Country:US
Practice Address - Phone:253-503-0459
Practice Address - Fax:253-301-1576
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA752924310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility