Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 450230 | CA |
NPI | 1568641868 |
---|---|
Provider Name | Ivy Njoloma |
First Address | Fontana, CA 92336-3781 |
Second Address | Fontana, CA 92336-3781 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2007 |
Last Update Date | 02/11/2007 |