Individual
ANTHONY KANGETHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
24259 GAZANIA WAY, LAKE ELSINORE, CA 92532-2736
(951) 581-0127
Mailing address
24259 GAZANIA WAY, LAKE ELSINORE, CA 92532-2736
(951) 581-0127
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95208703
CA
164X00000X
Licensed Vocational Nurse
VN263721
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
CA
Enumeration date
02/25/2015
Last updated
10/10/2020
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