Provider Demographics
NPI:1427765346
Name:NGUGI, GEOFFREY
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:NGUGI
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 1:10913 GLADLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-8800
Mailing Address - Country:US
Mailing Address - Phone:574-329-1509
Mailing Address - Fax:
Practice Address - Street 1:10913 GLADLANDS AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-8800
Practice Address - Country:US
Practice Address - Phone:574-329-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95083983163WH0200X, 163WP0200X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics