Healthcare Provider Details

I. General information

NPI: 1659169811
Provider Name (Legal Business Name): PETER RERAI NJOROGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 E 27TH ST
OAKLAND CA
94601-1912
US

IV. Provider business mailing address

2213 ROSE ST
BERKELEY CA
94709-1430
US

V. Phone/Fax

Practice location:
  • Phone: 510-536-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number42434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: