Provider Demographics
NPI:1558946632
Name:NGANGA-NAMASAKA, CAROLINE WAMBUI
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:WAMBUI
Last Name:NGANGA-NAMASAKA
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 1:2717 ANNAPOLIS CIR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4109
Mailing Address - Country:US
Mailing Address - Phone:214-476-9775
Mailing Address - Fax:
Practice Address - Street 1:2717 ANNAPOLIS CIR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4109
Practice Address - Country:US
Practice Address - Phone:214-476-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22096Medicaid