Provider Demographics
NPI:1023643459
Name:KERUBO, DAPHNE
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:KERUBO
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 1:2708 N RONO ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8359
Mailing Address - Country:US
Mailing Address - Phone:559-690-3928
Mailing Address - Fax:
Practice Address - Street 1:2708 N RONO ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8359
Practice Address - Country:US
Practice Address - Phone:559-690-3928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95096718163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse