Provider Demographics
NPI:1083138994
Name:KAMOTHO, ZIPPORAH WANJERI (LVN)
Entity Type:Individual
Prefix:
First Name:ZIPPORAH
Middle Name:WANJERI
Last Name:KAMOTHO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ZIPPORAH
Other - Middle Name:WANJERI
Other - Last Name:NYANDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11972 GADWALL DR
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2941
Mailing Address - Country:US
Mailing Address - Phone:951-547-9176
Mailing Address - Fax:
Practice Address - Street 1:11972 GADWALL DR
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91752-2941
Practice Address - Country:US
Practice Address - Phone:951-547-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN283457164X00000X
CA95262651163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse