Fidelia Kwamba Fiadoyor
Individual provider Active NPI Registered Nurse · Lathrop, CA
NPI 1710847355 · NPPES record last updated Nov 17, 2025
Key facts
- NPI
- 1710847355
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 664584 (CA)
- Practice address
- 129 Warren Ave
Lathrop, CA 95330-9715 - Phone
- (209) 774-6105
- NPI assigned
- Nov 17, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 664584 | CA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 664584 | CA | Yes |
Addresses
Primary practice location
129 Warren Ave
Lathrop, CA 95330-9715
Mailing address
129 Warren Ave
Lathrop, CA 95330-9715
Phone (209) 774-6105
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.