Healthcare Provider Details

I. General information

NPI: 1578159224
Provider Name (Legal Business Name): REGINA W NGOTHO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 ALBERTON CIR
LINCOLN CA
95648-3214
US

IV. Provider business mailing address

1329 ALBERTON CIR
LINCOLN CA
95648-3214
US

V. Phone/Fax

Practice location:
  • Phone: 781-526-5426
  • Fax:
Mailing address:
  • Phone: 781-526-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number289660
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95388641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: