Provider Demographics
NPI:1326801143
Name:LUNKUSE, PERUTH
Entity Type:Individual
Prefix:
First Name:PERUTH
Middle Name:
Last Name:LUNKUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 POSADA DEL SOL APT 9
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6350
Mailing Address - Country:US
Mailing Address - Phone:747-248-9613
Mailing Address - Fax:
Practice Address - Street 1:200 POSADA DEL SOL APT 9
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6350
Practice Address - Country:US
Practice Address - Phone:747-248-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214700038376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty