Provider Demographics
NPI:1114715604
Name:AWUONDA, HARRISON OMONDI
Entity type:Individual
Prefix:MR
First Name:HARRISON
Middle Name:OMONDI
Last Name:AWUONDA
Suffix:
Gender:
Credentials:
Other - Prefix:MRS
Other - First Name:OLIVIA
Other - Middle Name:MONGINA
Other - Last Name:NYANDIGISI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12406 W MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3453
Mailing Address - Country:US
Mailing Address - Phone:602-466-0785
Mailing Address - Fax:
Practice Address - Street 1:12406 W MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-3453
Practice Address - Country:US
Practice Address - Phone:602-466-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343900000X343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)