Provider Demographics
NPI:1649010901
Name:KIHAHU-WAMBUGU, MARY WAMBUI (LICENSED VOCATIONAL)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:WAMBUI
Last Name:KIHAHU-WAMBUGU
Suffix:
Gender:F
Credentials:LICENSED VOCATIONAL
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:WAMBUI
Other - Last Name:KIHAHU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4090 ELDERBERRY RDG
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2043
Mailing Address - Country:US
Mailing Address - Phone:714-204-7130
Mailing Address - Fax:
Practice Address - Street 1:4090 ELDERBERRY RDG
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2043
Practice Address - Country:US
Practice Address - Phone:714-204-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-25
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA736507164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse