Provider Demographics
NPI:1356526511
Name:MTHOMBENI, VERAH KENEILWE (NP)
Entity type:Individual
Prefix:MRS
First Name:VERAH
Middle Name:KENEILWE
Last Name:MTHOMBENI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1579
Mailing Address - Country:US
Mailing Address - Phone:909-478-7776
Mailing Address - Fax:909-478-7768
Practice Address - Street 1:25051 REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4099
Practice Address - Country:US
Practice Address - Phone:909-478-7776
Practice Address - Fax:909-478-7768
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376458363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health