Healthcare Provider Details

I. General information

NPI: 1134843188
Provider Name (Legal Business Name): JEDIDA NYAWIRA WANYOIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 GLACIER WAY
WEST COVINA CA
91791-4326
US

IV. Provider business mailing address

1530 GLACIER WAY
WEST COVINA CA
91791-4326
US

V. Phone/Fax

Practice location:
  • Phone: 281-760-8297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1095395
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95034356
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95409780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: