Provider Demographics
NPI:1548981376
Name:WANGATHIKA, VICTOR MORRISON
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:MORRISON
Last Name:WANGATHIKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 E ANGEL DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5707
Mailing Address - Country:US
Mailing Address - Phone:480-825-5107
Mailing Address - Fax:
Practice Address - Street 1:482 E ANGEL DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5707
Practice Address - Country:US
Practice Address - Phone:480-825-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ259238163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health