Active NPI
Elijah Kihara Kamotho
- Licensed Vocational Nurse
- Menifee, CA
National Provider Identifier
1104382506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- VN283551
- Practice address
- 30362 Blue Cedar Dr
Menifee, CA 92584-2744 - Phone
- (714) 452-4439
- NPI assigned
- Feb 11, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | VN283551 | CA | Primary |
Addresses
Primary practice location
30362 Blue Cedar Dr
Menifee, CA 92584-2744
Mailing address
30362 Blue Cedar Dr
Menifee, CA 92584-2744
Phone (714) 452-4439
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| VN283551 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613606400000",
"number": "1104382506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30362 BLUE CEDAR DR",
"city": "MENIFEE",
"state": "CA",
"postal_code": "925842744",
"telephone_number": "714-452-4439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30362 BLUE CEDAR DR",
"city": "MENIFEE",
"state": "CA",
"postal_code": "925842744",
"telephone_number": "714-452-4439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAMOTHO",
"first_name": "ELIJAH",
"middle_name": "KIHARA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-11",
"last_updated": "2021-02-18",
"certification_date": "2021-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "VN283551",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Menifee, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.