Provider Demographics
NPI:1154726974
Name:MBURU, ELIZABETH WARIARA
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:WARIARA
Last Name:MBURU
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:WARIARA
Other - Last Name:MBURU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:19191 S VERMONT AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1049
Mailing Address - Country:US
Mailing Address - Phone:310-630-2315
Mailing Address - Fax:310-354-6201
Practice Address - Street 1:19191 S VERMONT AVE STE 300
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1049
Practice Address - Country:US
Practice Address - Phone:310-630-2315
Practice Address - Fax:310-354-6201
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23704163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice