Healthcare Provider Details

I. General information

NPI: 1003524844
Provider Name (Legal Business Name): LEAH WAMBUI GATIMU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 SEMINARY AVE # 1
OAKLAND CA
94605-1307
US

IV. Provider business mailing address

716 TURQUOISE DR
HERCULES CA
94547-1763
US

V. Phone/Fax

Practice location:
  • Phone: 510-631-0333
  • Fax:
Mailing address:
  • Phone: 707-486-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020930
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN639296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: