Provider Demographics
NPI:1003524844
Name:GATIMU, LEAH WAMBUI
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:WAMBUI
Last Name:GATIMU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 TURQUOISE DR
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1763
Mailing Address - Country:US
Mailing Address - Phone:707-486-0340
Mailing Address - Fax:
Practice Address - Street 1:2521 SEMINARY AVE # 1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-1307
Practice Address - Country:US
Practice Address - Phone:510-631-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN639296163W00000X
CA95020930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse