Provider Demographics
NPI:1902324114
Name:NGANGA, PETER N
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:N
Last Name:NGANGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 BECKETT FIELD LANE
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3446
Mailing Address - Country:US
Mailing Address - Phone:559-410-6555
Mailing Address - Fax:
Practice Address - Street 1:7204 BECKETT FIELD LN
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3446
Practice Address - Country:US
Practice Address - Phone:559-410-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA789167163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine