Provider Demographics
NPI:1669269668
Name:NDERITU, JUSTIN NGARI (MSN, RN)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:NGARI
Last Name:NDERITU
Suffix:
Gender:
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 W SANTA CRUZ WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1178
Mailing Address - Country:US
Mailing Address - Phone:574-360-4833
Mailing Address - Fax:
Practice Address - Street 1:153 W SANTA CRUZ WAY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOUSE
Practice Address - State:CA
Practice Address - Zip Code:95391-1178
Practice Address - Country:US
Practice Address - Phone:574-360-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA708281163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse