Provider Demographics
NPI:1194726984
Name:MOITE, WANJIKU ANN MAXINE (MD)
Entity type:Individual
Prefix:DR
First Name:WANJIKU
Middle Name:ANN MAXINE
Last Name:MOITE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1172 N MACLAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1328
Mailing Address - Country:US
Mailing Address - Phone:818-898-1388
Mailing Address - Fax:818-365-4031
Practice Address - Street 1:7843 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-2523
Practice Address - Country:US
Practice Address - Phone:818-765-8656
Practice Address - Fax:818-765-6982
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA70738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I25289Medicare UPIN