Provider Demographics
NPI:1184414286
Name:KIBARA, MAUREEN NYAMBURA
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:NYAMBURA
Last Name:KIBARA
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 1:961 E PHILLIPS BLVD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-7553
Mailing Address - Country:US
Mailing Address - Phone:302-465-2094
Mailing Address - Fax:
Practice Address - Street 1:961 E PHILLIPS BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7553
Practice Address - Country:US
Practice Address - Phone:302-465-2094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA750729164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse