Provider Demographics
NPI:1215338207
Name:MUGO, PAUL MURIUKI
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MURIUKI
Last Name:MUGO
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 1:301 N FAUDREE RD APT 912
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765
Mailing Address - Country:US
Mailing Address - Phone:980-320-6229
Mailing Address - Fax:
Practice Address - Street 1:1200 W 15TH ST
Practice Address - Street 2:
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-1478
Practice Address - Country:US
Practice Address - Phone:432-943-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117955225XN1300X
NC9005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility