Healthcare Provider Details

I. General information

NPI: 1659169811
Provider Name (Legal Business Name): PETER RERAI NJOROGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 GEARY ST
SAN FRANCISCO CA
94109-7228
US

IV. Provider business mailing address

822 GEARY ST
SAN FRANCISCO CA
94109-7228
US

V. Phone/Fax

Practice location:
  • Phone: 628-216-0303
  • Fax: 415-419-6196
Mailing address:
  • Phone: 628-216-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number42434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: