Healthcare Provider Details

I. General information

NPI: 1447075585
Provider Name (Legal Business Name): PATRICK PASHA NJUGUNA LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 COUNTY FARM RD
RIVERSIDE CA
92503-3678
US

IV. Provider business mailing address

4082 OVERLAND ST
RIVERSIDE CA
92503-4039
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-2499
  • Fax:
Mailing address:
  • Phone: 951-345-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number217928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: