Healthcare Provider Details

I. General information

NPI: 1831828607
Provider Name (Legal Business Name): DAVID WILLIAM NGANGA LVN/RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5799 DAYBREAK DR APT A
EASTVALE CA
91752-6695
US

IV. Provider business mailing address

5799 DAYBREAK DR APT A
EASTVALE CA
91752-6695
US

V. Phone/Fax

Practice location:
  • Phone: 323-687-5904
  • Fax:
Mailing address:
  • Phone: 323-687-5904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number719074
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number111276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: