Provider Demographics
NPI:1215750021
Name:KANGETHE, ANTON Y
Entity type:Individual
Prefix:
First Name:ANTON Y
Middle Name:
Last Name:KANGETHE
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 1:621 AROMAS PL
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-2673
Mailing Address - Country:US
Mailing Address - Phone:323-331-6269
Mailing Address - Fax:
Practice Address - Street 1:621 AROMAS PL
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-2673
Practice Address - Country:US
Practice Address - Phone:323-331-6269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95097701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse