Healthcare Provider Details

I. General information

NPI: 1083126684
Provider Name (Legal Business Name): LIGIA SORAYA ABOHANDE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIGIA SORAYA ABOHANDE HENRIQUEZ

II. Dates (important events)

Enumeration Date: 11/04/2017
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 SAMARITAN DR
SAN JOSE CA
95124
US

IV. Provider business mailing address

P.O BOX 320122
LOS GATOS CA
95032
US

V. Phone/Fax

Practice location:
  • Phone: 408-616-0649
  • Fax:
Mailing address:
  • Phone: 408-616-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021628
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number95108942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: