Provider Demographics
NPI:1194569707
Name:OWINO, MICHAEL MONGA
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MONGA
Last Name:OWINO
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 1:9358 LOST SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4800
Mailing Address - Country:US
Mailing Address - Phone:916-247-4910
Mailing Address - Fax:
Practice Address - Street 1:9358 LOST SPRINGS CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4800
Practice Address - Country:US
Practice Address - Phone:916-247-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle