Provider Demographics
NPI:1447899315
Name:MWARABU, MARTIN
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:MWARABU
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 1:237 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-4621
Mailing Address - Country:US
Mailing Address - Phone:904-349-9957
Mailing Address - Fax:
Practice Address - Street 1:237 DARTMOUTH DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-4621
Practice Address - Country:US
Practice Address - Phone:904-349-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)