Individual
CHARLES MWANGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3800 S FLAMINGO RD, DAVIE, FL 33330-1616
(954) 473-0167
(954) 473-0202
Mailing address
3800 S FLAMINGO RD, DAVIE, FL 33330-1616
(954) 473-0167
(954) 473-0202
Taxonomy
Speciality
Code
Description
License number
State
374T00000X
Religious Nonmedical Nursing Personnel
Primary
—
—
376G00000X
Nursing Home Administrator
—
—
Other
Enumeration date
08/30/2012
Last updated
08/30/2012
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