Provider Demographics
NPI:1326330382
Name:GITONGU, SAMUEL KIBE (RN)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KIBE
Last Name:GITONGU
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2026
Mailing Address - Country:US
Mailing Address - Phone:302-753-3696
Mailing Address - Fax:
Practice Address - Street 1:4131 PEARL ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2026
Practice Address - Country:US
Practice Address - Phone:302-753-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95401315163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse