Healthcare Provider Details

I. General information

NPI: 1558945956
Provider Name (Legal Business Name): CLEMENTINE NAMBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 TEMECULA PKWY
TEMECULA CA
92592-5896
US

IV. Provider business mailing address

31700 TEMECULA PKWY
TEMECULA CA
92592-5896
US

V. Phone/Fax

Practice location:
  • Phone: 951-331-2539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD496597
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: