Provider Demographics
NPI:1710595707
Name:MWANGI, TITUS KIMANI
Entity type:Individual
Prefix:
First Name:TITUS
Middle Name:KIMANI
Last Name:MWANGI
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 1:5625 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-5247
Mailing Address - Country:US
Mailing Address - Phone:858-386-6705
Mailing Address - Fax:602-603-3981
Practice Address - Street 1:5625 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-5247
Practice Address - Country:US
Practice Address - Phone:858-386-6705
Practice Address - Fax:602-603-3981
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician