Provider Demographics
NPI:1174180905
Name:NGANGA, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:NGANGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:WAITHIRA
Other - Last Name:NJOROGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42061 ORANGE BLOSSOM DRIVE
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:760-807-3744
Mailing Address - Fax:
Practice Address - Street 1:42061 ORANGE BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5543
Practice Address - Country:US
Practice Address - Phone:760-807-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231959164X00000X
CA95253715163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse