Healthcare Provider Details

I. General information

NPI: 1851225056
Provider Name (Legal Business Name): DR. GUILIANE DJOUMEKOUM NKENDONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25590 PROSPECT AVE APT 30B
LOMA LINDA CA
92354-3151
US

IV. Provider business mailing address

25590 PROSPECT AVE APT 30B
LOMA LINDA CA
92354-3151
US

V. Phone/Fax

Practice location:
  • Phone: 408-702-5951
  • Fax:
Mailing address:
  • Phone: 408-702-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: