Provider Demographics
NPI:1336893155
Name:MACHARIA, JOHN NJOROGE
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NJOROGE
Last Name:MACHARIA
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 1:3697 EDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-7827
Mailing Address - Country:US
Mailing Address - Phone:916-607-4548
Mailing Address - Fax:
Practice Address - Street 1:3697 EDINGTON DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-7827
Practice Address - Country:US
Practice Address - Phone:916-607-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264307164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse