Provider Demographics
NPI:1295204097
Name:LYIMO, KHALFANI
Entity Type:Individual
Prefix:
First Name:KHALFANI
Middle Name:
Last Name:LYIMO
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 1:2380 SIERRA BLVD APT 112
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4729
Mailing Address - Country:US
Mailing Address - Phone:240-470-3093
Mailing Address - Fax:
Practice Address - Street 1:2380 SIERRA BLVD APT 112
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4729
Practice Address - Country:US
Practice Address - Phone:240-470-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider