Provider Demographics
NPI:1043895279
Name:WAITHAKA, JAMES N
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:N
Last Name:WAITHAKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 E BARHAM DR SPC 125
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4542
Mailing Address - Country:US
Mailing Address - Phone:619-316-3574
Mailing Address - Fax:
Practice Address - Street 1:2325 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5711
Practice Address - Country:US
Practice Address - Phone:760-473-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD4617944OtherDRIVER LICENSE