Provider Demographics
NPI:1528719945
Name:NDUNGU, ELIZABETH WANGARI
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WANGARI
Last Name:NDUNGU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1429
Mailing Address - Country:US
Mailing Address - Phone:909-587-3527
Mailing Address - Fax:
Practice Address - Street 1:25284 COTTAGE AVE APT K2
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2352
Practice Address - Country:US
Practice Address - Phone:909-587-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246077164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse