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General NPI Number Information
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NPI Number | 1497042188
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Entity Type | Individual
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Provider Name | ELIZABETH WANYAM NDISANG C.N.A
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Gender | Female
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 2114 W EL SEGUNDO BLVD APT 1
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City | GARDENA
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State | CA
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Zip | 90249-1722
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Country | US
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Telephone | 310-227-1760
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Fax |
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Provider Business Mailing Address
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Address Line | 2114 W EL SEGUNDO BLVD APT 1
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City | GARDENA
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State | CA
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Zip | 90249-1722
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Country | US
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Telephone | 310-227-1760
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 00198671
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 00641181
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License Number State | CA
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