Provider Demographics
NPI:1659949758
Name:TSIMBA ZENGA, IRENE NONE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MISS
First Name:IRENE
Middle Name:NONE
Last Name:TSIMBA ZENGA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:14758 MARTELL AVE APT C
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-4450
Mailing Address - Country:US
Mailing Address - Phone:510-586-5603
Mailing Address - Fax:
Practice Address - Street 1:6475 CHRISTIE AVE
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1095
Practice Address - Country:US
Practice Address - Phone:510-982-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95211006163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95211006OtherREGISTERED NURSE LICENSE