Provider Demographics
NPI:1255162772
Name:KIGOONYA, VIOLET (FNP)
Entity type:Individual
Prefix:
First Name:VIOLET
Middle Name:
Last Name:KIGOONYA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 SAN GABRIEL
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-1905
Mailing Address - Country:US
Mailing Address - Phone:310-598-0875
Mailing Address - Fax:
Practice Address - Street 1:1108 SAN GABRIEL
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-1905
Practice Address - Country:US
Practice Address - Phone:310-598-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily