Healthcare Provider Details

I. General information

NPI: 1497568679
Provider Name (Legal Business Name): MOKETTA NASHA HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11546 216TH ST
LAKEWOOD CA
90715-2535
US

IV. Provider business mailing address

11546 216TH ST
LAKEWOOD CA
90715-2535
US

V. Phone/Fax

Practice location:
  • Phone: 424-414-3713
  • Fax:
Mailing address:
  • Phone: 424-414-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number6073665740
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberD8112974
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: