MEDICARE: MRS. KENYA NEOKO SINGLETON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	535373	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13657	OTHER	CA	FURNISHING NUMBER

General Provider Information

NPI Number	:	1003901638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENYA NEOKO SINGLETON FNP

Provider Business Mailing Address
First Line	:	7916 SAN BENITO STREET
Second Line	:
City	:	HIGHLAND
State	:	CA
Zip	:	92346-6353
Country	:	US
Telephone Number	:	909-335-2435
Fax Number	:

Provider Business Practice Location Address
First Line	:	11201 BENTON STREET
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92357-0000
Country	:	US
Telephone Number	:	909-825-7084
Fax Number	:	909-777-3874

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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