FANTA MBOKA (NPI# 1821552365) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821552365 |
| Entity Type | Individual |
| Full Name | FANTA MBOKA |
| Practice Address |
1904 Richland Ave Bldg A Ceres CA 95307-4562 |
| Mailing Address |
4211 Motif Ct Turlock CA 95382-7399 |
| Practice Telephone | 2093008800 |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2019-01-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
739503 | CA | Nursing Service Providers |
| Street Address |
1904 RICHLAND AVE BLDG A |
| City | CERES |
| State | CA |
| Zip Code | 95307-4562 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609389600 | Crystal Hewes | Case Manager/Care Coordinator | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2017-11-13 |
| 1659839132 | Cherry Parayno | Case Manager/Care Coordinator | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2019-03-04 |
| 1427512953 | Erin Ortiz | Case Manager/Care Coordinator | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2019-01-29 |
| 1679037105 | Esmeralda Rizo | Case Manager/Care Coordinator | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2019-01-29 |
| 1730650102 | Barbara Loving | Registered Nurse | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2018-12-11 |
| 1174094742 | Simarjeet Singh Sahota | Licensed Vocational Nurse | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2018-12-07 |
| 1629549282 | Rowena Chung | Case Manager/Care Coordinator | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2018-12-07 |
| 1063992006 | Roberto Vargas-pantoja | Licensed Vocational Nurse | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2018-08-20 |
| 1912487950 | Michele Methvin | Licensed Vocational Nurse | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2018-08-20 |
| 1124508007 | Olufunke Olukoga | Licensed Vocational Nurse | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2018-08-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144762022 | Roxanne Mata | Technician | 1904 Richland Ave., Ceres, CA 95307 | 2016-11-09 |
| 1023496379 | Steven Leonard II | Technician, Other | 1904 Richalnd Ave, Ceres, CA 95307 | 2015-05-07 |
| 1942619820 | Thevi Phanthalangsy | Pharmacist | 1421 Coffee Road, Modesto, CA 95307 | 2014-08-05 |
| 1588973937 | Gloria June Coats | Nurse Practitioner | 3641 Mitchell Road, Suite H, Ceres, CA 95307 | 2010-10-04 |
| 1992953236 | John H Meekay | Dentist | 1788 Mitchell Road Suite 105, Ceres, CA 95307 | 2008-08-28 |
| 1316073778 | Donna J Payne | Case Manager/Care Coordinator | 1904 Richland Avenue, Ceres, CA 95307 | 2007-02-27 |
| 1104994656 | Katherine Anne Kucera | Dentist | 3507 Morgan Rd, Ceres, CA 95307 | 2006-12-01 |
| 1073615084 | Tracy S Park | Dentist | 2760 3rd Street, Suite A, Ceres, CA 95307 | 2006-09-01 |
| 1902855588 | Kerry B Evnin Md Inc A Professional Medical Corporation | Family Medicine | 3641 Mitchell Rd, H, Ceres, CA 95307 | 2006-05-09 |
| 1376012559 | David Andrew Kirkpatrick | Technician | 1904 Richland Ave Bldg D, Ceres, CA 95307 | 2018-11-17 |
| Find all providers in zip 95307 | ||||
| Taxonomy Code | 163WP0808X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124651294 | Ash Singh | Registered Nurse | 1904 Richland Ave, Ceres, CA 95307-4562 | 2020-02-18 |
| 1215585716 | Praveena Devi Pal | Registered Nurse | 1904 Richland Ave, Ceres, CA 95307-4562 | 2019-08-28 |
| 1124683008 | Joanna Kristine Affolter | Registered Nurse | 1904 Richland Ave, Ceres, CA 95307-4562 | 2019-05-06 |
| 1730650102 | Barbara Loving | Registered Nurse | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2018-12-11 |
| 1568947141 | Christine Marie Ehrler | Registered Nurse | 1904 Richland Ave Bldg F, Ceres, CA 95307-4562 | 2018-09-28 |
| 1861972804 | Angel Garcia | Registered Nurse | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2018-08-20 |
| 1053809871 | Navneet Gill | Registered Nurse | 1904 Richland Ave Bldg A, Ceres, CA 95307-4562 | 2018-04-26 |
| 1598253585 | Eric Shambourger | Registered Nurse | 1904 Richland Ave, Ceres, CA 95307-4562 | 2018-04-25 |
| 1598279077 | Michele Nielsen | Registered Nurse | 1904 Richland Ave, Ceres, CA 95307-4562 | 2017-11-20 |
| 1669983375 | Alysa Maren Sparkman-mendoza | Registered Nurse | 1904 Richland Ave, Ceres, CA 95307-4562 | 2017-10-20 |
| Find all providers in CERES | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.