Provider Demographics
NPI:1619427275
Name:ANYENEH, CAROLINE CHIGOZIE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:CHIGOZIE
Last Name:ANYENEH
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 1:3200 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-9715
Mailing Address - Country:US
Mailing Address - Phone:831-256-2157
Mailing Address - Fax:
Practice Address - Street 1:3200 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-9715
Practice Address - Country:US
Practice Address - Phone:831-265-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81-1967412343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)