Provider Demographics
NPI:1306423009
Name:TOMBEGOU, MAWAYIDNA TIWARIKA (NP)
Entity type:Individual
Prefix:
First Name:MAWAYIDNA
Middle Name:TIWARIKA
Last Name:TOMBEGOU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13690 E 14TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2584
Mailing Address - Country:US
Mailing Address - Phone:510-239-3048
Mailing Address - Fax:
Practice Address - Street 1:1345 TURK ST APT 206
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-8720
Practice Address - Country:US
Practice Address - Phone:415-309-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015556363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care