Provider Demographics
NPI:1669099032
Name:IRUNGU, JACINTA
Entity type:Individual
Prefix:
First Name:JACINTA
Middle Name:
Last Name:IRUNGU
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 1:9959 ADLETA BLVD APT 1906
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8142
Mailing Address - Country:US
Mailing Address - Phone:940-595-7124
Mailing Address - Fax:
Practice Address - Street 1:9959 ADLETA BLVD APT 1906
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8142
Practice Address - Country:US
Practice Address - Phone:940-595-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse