Healthcare Provider Details

I. General information

NPI: 1902747660
Provider Name (Legal Business Name): JANET NALWEYISO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18245 MILLBROOK AVE 18245 MILLBROOK AVE
LATHROP CA
95330
US

IV. Provider business mailing address

18245 MILLBROOK AVE
LATHROP CA
95330-9234
US

V. Phone/Fax

Practice location:
  • Phone: 805-433-1400
  • Fax: 805-433-1400
Mailing address:
  • Phone: 805-433-1400
  • Fax: 805-433-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number95345722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: