Provider Demographics
NPI:1013556141
Name:WAMBUGU, ROSALIND
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:
Last Name:WAMBUGU
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 1:1709 ADONIS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-1701
Mailing Address - Country:US
Mailing Address - Phone:916-254-2293
Mailing Address - Fax:
Practice Address - Street 1:137 N COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6646
Practice Address - Country:US
Practice Address - Phone:916-254-2293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2023-07-13
Deactivation Date:2022-02-02
Deactivation Code:
Reactivation Date:2022-10-03
Provider Licenses
StateLicense IDTaxonomies
CARN95165116163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE2694723OtherYOLO COUNTY