Watson Kambenja

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

95036777 Issued in CA

Practice address

PO Box 7899
South Lake Tahoe, CA 96158-0899

Phone

(916) 644-0951

NPI assigned

Sep 10, 2025

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1720969181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3408 CHATHAM ST",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957651766",
            "telephone_number": "530-318-4889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 7899",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961580899",
            "telephone_number": "916-644-0951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMBENJA",
        "first_name": "WATSON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-09-10",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95036777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jorge Perez MD LTD
• Cristene Adel Jory, HHP, AWC
• Katrina Gabrielle Joy, RN
• Michael Juckett
• Richard Leland Kahn, OD
• Alyna Azalia Vera Kane
• Nicole Karetov, RD
• Jeanie F Kaufman, D.D.S.
• Raoul L Kaufman, MARRIAGE FAMILY THER
• Linda Penney Keel, PH.D.

• Gerontology Nurse Practitioner in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Gerontology Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.