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General NPI Number Information
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NPI Number | 1720969181
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Entity Type | Individual
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Provider Name | WATSON KAMBENJA
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Gender | Male
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | PO BOX 7899
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96158-0899
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Country | US
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Telephone | 916-644-0951
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Fax |
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Provider Business Mailing Address
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Address Line | 3408 CHATHAM ST
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City | ROCKLIN
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State | CA
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Zip | 95765-1766
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Country | US
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Telephone | 530-318-4889
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 95036777
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License Number State | CA
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