Provider Demographics
NPI:1982311908
Name:KOSGEI, JOAN CHEROTICH
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:CHEROTICH
Last Name:KOSGEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 BLUE RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4159
Mailing Address - Country:US
Mailing Address - Phone:925-350-9965
Mailing Address - Fax:
Practice Address - Street 1:2342 BLUE RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4159
Practice Address - Country:US
Practice Address - Phone:925-350-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA696493163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical