Healthcare Provider Details

I. General information

NPI: 1326411141
Provider Name (Legal Business Name): LUCY NJUGUNA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15188 LA CASA DR
MORENO VALLEY CA
92555-5837
US

IV. Provider business mailing address

15188 LA CASA DR
MORENO VALLEY CA
92555-5837
US

V. Phone/Fax

Practice location:
  • Phone: 951-992-9533
  • Fax:
Mailing address:
  • Phone: 951-992-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number738801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: