Provider Demographics
NPI:1083126684
Name:ABOHANDE, LIGIA SORAYA (FNP)
Entity Type:Individual
Prefix:
First Name:LIGIA
Middle Name:SORAYA
Last Name:ABOHANDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LIGIA
Other - Middle Name:SORAYA
Other - Last Name:ABOHANDE HENRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O BOX 320122
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-616-0649
Mailing Address - Fax:
Practice Address - Street 1:2425 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-616-0649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-04
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021628363LF0000X
CA95108942163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care