Provider Demographics
NPI:1427628338
Name:MBENGUE, FATOU SAMB (LVN)
Entity type:Individual
Prefix:MISS
First Name:FATOU
Middle Name:SAMB
Last Name:MBENGUE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27753 LAFAYETTE WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5714
Mailing Address - Country:US
Mailing Address - Phone:951-801-2205
Mailing Address - Fax:951-801-2205
Practice Address - Street 1:27753 LAFAYETTE WAY
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-5714
Practice Address - Country:US
Practice Address - Phone:951-801-2205
Practice Address - Fax:951-801-2205
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN695828164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse