Provider Demographics
NPI:1962832089
Name:GITAU, AGNES
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:GITAU
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 1:3001 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3851
Mailing Address - Country:US
Mailing Address - Phone:916-241-9844
Mailing Address - Fax:916-241-9845
Practice Address - Street 1:3001 DOUGLAS BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3851
Practice Address - Country:US
Practice Address - Phone:916-241-9844
Practice Address - Fax:916-241-9845
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23285363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology