Healthcare Provider Details

I. General information

NPI: 1609784347
Provider Name (Legal Business Name): BEATRICE KIBATHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 LOS GUILUCOS RD
SANTA ROSA CA
95409
US

IV. Provider business mailing address

1622 BECKY CT
SANTA ROSA CA
95403-2564
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-6344
  • Fax: 707-565-6371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number163W
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: