Provider Demographics
NPI:1356918650
Name:NAKIBUULE, SOPHIA (LVN)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:NAKIBUULE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 MONOGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-4109
Mailing Address - Country:US
Mailing Address - Phone:818-263-9541
Mailing Address - Fax:
Practice Address - Street 1:9001 MONOGRAM AVE
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-4109
Practice Address - Country:US
Practice Address - Phone:818-263-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252059164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse