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General NPI Number Information
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NPI Number | 1073741039
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Entity Type | Organization
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Legal Business Name | J KAGWA-NYANZI PEDIATRICS CLINIC INC
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 117 W WILLOW ST STE B
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City | POMONA
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State | CA
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Zip | 91768-1829
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Country | US
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Telephone | 909-865-5519
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Fax |
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Provider Business Mailing Address
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Address Line | 117 W WILLOW ST STE B
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City | POMONA
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State | CA
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Zip | 91768-1829
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Country | US
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Telephone | 909-865-5519
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JUANITA KAGWA
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Credential | MD
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Telephone | 909-865-5519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A45809
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License Number State | CA
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