Provider Demographics
NPI:1316772502
Name:MAINA, ALEX KANGETHE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:KANGETHE
Last Name:MAINA
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 OAKLEY CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6357
Mailing Address - Country:US
Mailing Address - Phone:913-544-5902
Mailing Address - Fax:
Practice Address - Street 1:1819 OAKLEY CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-6357
Practice Address - Country:US
Practice Address - Phone:913-544-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA819682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse