Healthcare Provider Details

I. General information

NPI: 1518538255
Provider Name (Legal Business Name): JEFFER CHERENGETI KIPROTCIH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2021
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 SANBORN AVE
LA CRESCENTA CA
91214-2920
US

IV. Provider business mailing address

2721 SANBORN AVE
LA CRESCENTA CA
91214-2920
US

V. Phone/Fax

Practice location:
  • Phone: 626-354-1798
  • Fax:
Mailing address:
  • Phone: 626-689-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN95201800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: