Healthcare Provider Details

I. General information

NPI: 1063989127
Provider Name (Legal Business Name): ROSEMOND NUNGE NGUIFFO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

IV. Provider business mailing address

1893 FIORITA WAY
BRENTWOOD CA
94513-7222
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-4000
  • Fax:
Mailing address:
  • Phone: 925-325-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: