Healthcare Provider Details

I. General information

NPI: 1134987688
Provider Name (Legal Business Name): RONI-JO PANGANIBAN NAVAL MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 B GALE WILSON BLVD
FAIRFIELD CA
94533-3587
US

IV. Provider business mailing address

7009 STONEBROOKE DR
VALLEJO CA
94591-8701
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-5000
  • Fax:
Mailing address:
  • Phone: 707-319-4755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: