Provider Demographics
NPI:1801324215
Name:MUTIRO, VIMBAI
Entity type:Individual
Prefix:
First Name:VIMBAI
Middle Name:
Last Name:MUTIRO
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 1:808 SILVERMOON DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0137
Mailing Address - Country:US
Mailing Address - Phone:972-750-2414
Mailing Address - Fax:
Practice Address - Street 1:808 SILVERMOON DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-0137
Practice Address - Country:US
Practice Address - Phone:972-750-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health