Provider Demographics
NPI:1235699406
Name:BAJIBA, WELIYA M (APRN)
Entity type:Individual
Prefix:
First Name:WELIYA
Middle Name:M
Last Name:BAJIBA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 CENTRAL PARK DR APT 924
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3519
Mailing Address - Country:US
Mailing Address - Phone:407-844-2934
Mailing Address - Fax:
Practice Address - Street 1:414 G ST STE 208
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5669
Practice Address - Country:US
Practice Address - Phone:530-741-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9328983363LF0000X
CANP95011338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty