Provider Demographics
NPI:1376898833
Name:SERUNJOGI, MARIAN NAKIJOBA (FNP)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:NAKIJOBA
Last Name:SERUNJOGI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27656 IRIS PL
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3792
Mailing Address - Country:US
Mailing Address - Phone:661-775-1832
Mailing Address - Fax:
Practice Address - Street 1:1911 W GLENOAKS BLVD STE B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-4746
Practice Address - Country:US
Practice Address - Phone:818-843-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA500443OtherREGISTERED NURSE
CA76100OtherPUBLIC HEALTH NURSE
CA21882OtherFAMILY NURSE PRACTICTIONER