Healthcare Provider Details

I. General information

NPI: 1093393670
Provider Name (Legal Business Name): DAMARIS NJERI KINUTHIA KITENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9279 THILOW DR
SACRAMENTO CA
95826-4116
US

IV. Provider business mailing address

9279 THILOW DR
SACRAMENTO CA
95826-4116
US

V. Phone/Fax

Practice location:
  • Phone: 916-229-7604
  • Fax:
Mailing address:
  • Phone: 916-229-7604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95209303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: