Healthcare Provider Details

I. General information

NPI: 1235619883
Provider Name (Legal Business Name): MARGARET ADHIAMBO RAYOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 N MARQUIS WAY
MOUNTAIN HOUSE CA
95391-1288
US

IV. Provider business mailing address

734 N MARQUIS WAY
MOUNTAIN HOUSE CA
95391-1288
US

V. Phone/Fax

Practice location:
  • Phone: 408-480-0726
  • Fax:
Mailing address:
  • Phone: 408-448-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number631993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: