Provider Demographics
NPI:1699419366
Name:MAYENGO, CAROLINE NAMIREMBE (DNP, AGPNP-C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:NAMIREMBE
Last Name:MAYENGO
Suffix:
Gender:F
Credentials:DNP, AGPNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5801
Mailing Address - Country:US
Mailing Address - Phone:323-737-5200
Mailing Address - Fax:323-737-5400
Practice Address - Street 1:1655 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5801
Practice Address - Country:US
Practice Address - Phone:323-737-5200
Practice Address - Fax:323-737-5400
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020746363LA2200X, 363LG0600X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care