1205279502 NPI number — CATHERINE W MUGAMBI

Table of content: CATHERINE W MUGAMBI (NPI 1205279502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205279502 NPI number — CATHERINE W MUGAMBI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUGAMBI
Provider First Name:
CATHERINE
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205279502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4540 WOODRIDGE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77365-7714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-741-1008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21580 LOOP 494
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CANEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77357-8239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-577-8880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  117503 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 207164901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149984001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com