Healthcare Provider Details

I. General information

NPI: 1891623211
Provider Name (Legal Business Name): IMEE LAURENARIA JANABAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2754 COBBLER ST
MANTECA CA
95337-8723
US

IV. Provider business mailing address

2754 COBBLER ST
MANTECA CA
95337-8723
US

V. Phone/Fax

Practice location:
  • Phone: 209-305-7584
  • Fax:
Mailing address:
  • Phone: 209-305-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95038734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: