Healthcare Provider Details

I. General information

NPI: 1669960001
Provider Name (Legal Business Name): NGABO SAFARI NZIGIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19950 RINALDI ST STE 300
PORTER RANCH CA
91326-4254
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 818-271-2400
  • Fax: 818-271-2401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA157762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: