Provider Demographics
NPI:1700487691
Name:MAUMALANGA, HINE
Entity Type:Individual
Prefix:
First Name:HINE
Middle Name:
Last Name:MAUMALANGA
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 1:1094 FOLSOM AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-5704
Mailing Address - Country:US
Mailing Address - Phone:510-564-5722
Mailing Address - Fax:
Practice Address - Street 1:1094 FOLSOM AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-5704
Practice Address - Country:US
Practice Address - Phone:510-564-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider