Provider Demographics
NPI:1982305611
Name:GITONGA, PETRONILLA MUKUBA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:PETRONILLA
Middle Name:MUKUBA
Last Name:GITONGA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7393 RIVER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-3457
Mailing Address - Country:US
Mailing Address - Phone:951-454-3915
Mailing Address - Fax:
Practice Address - Street 1:7393 RIVER GLEN DR
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-3457
Practice Address - Country:US
Practice Address - Phone:951-454-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95268115163WC0200X, 163WM0705X, 163W00000X
CA564301163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical