Provider Demographics
NPI:1518389634
Name:NJUGUNA, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:NJUGUNA
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 1:1083 CIRCLE CITY DR
Mailing Address - Street 2:# 105
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-5714
Mailing Address - Country:US
Mailing Address - Phone:781-526-0045
Mailing Address - Fax:
Practice Address - Street 1:1083 CIRCLE CITY DR
Practice Address - Street 2:# 105
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-5714
Practice Address - Country:US
Practice Address - Phone:781-526-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201335710379343900000X
CA46 44088766343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46 - 4408766Medicaid