Provider Demographics
NPI:1568279214
Name:JAJA, GEORGE GBUBEMI
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:GBUBEMI
Last Name:JAJA
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 1:2740 FULTON AVE STE 101-53
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5108
Mailing Address - Country:US
Mailing Address - Phone:702-372-5241
Mailing Address - Fax:
Practice Address - Street 1:2740 FULTON AVE STE 101-53
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5108
Practice Address - Country:US
Practice Address - Phone:702-372-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347E00000X
CA8UWH688347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker