Healthcare Provider Details

I. General information

NPI: 1780103291
Provider Name (Legal Business Name): CAROLINE NAJJUMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

IV. Provider business mailing address

19800 ATASCOCITA SHORES DR APT 535
HUMBLE TX
77346-2371
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-3551
  • Fax:
Mailing address:
  • Phone: 12817981636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95008101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: