Provider Demographics
NPI:1134986938
Name:RUTASHONGERWA, DANIELLA K
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:K
Last Name:RUTASHONGERWA
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 1:2121 VALE RD APT 46
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3856
Mailing Address - Country:US
Mailing Address - Phone:510-650-5172
Mailing Address - Fax:
Practice Address - Street 1:2121 VALE RD APT 46
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3856
Practice Address - Country:US
Practice Address - Phone:510-650-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA711694163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical