Provider Demographics
NPI:1538836192
Name:NGATHO, NZILA
Entity type:Individual
Prefix:
First Name:NZILA
Middle Name:
Last Name:NGATHO
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 1:24631 ORMISTA DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3804
Mailing Address - Country:US
Mailing Address - Phone:951-337-8953
Mailing Address - Fax:
Practice Address - Street 1:24631 ORMISTA DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3804
Practice Address - Country:US
Practice Address - Phone:951-337-8953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222287164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse