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General NPI Number Information
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NPI Number | 1457653438
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Entity Type | Individual
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Provider Name | RITA IMAH R.N., M.S.N, F.N.P,
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Gender | Female
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 1617 CANYON DR
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City | PINOLE
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State | CA
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Zip | 94564-2151
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Country | US
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Telephone | 510-685-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 1066 REGATTA PT
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City | HERCULES
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State | CA
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Zip | 94547-2603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 20353
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License Number State | CA
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