Healthcare Provider Details

I. General information

NPI: 1447163316
Provider Name (Legal Business Name): MICHAEL C EKEAGWU RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 E 215TH ST
CARSON CA
90745-1815
US

IV. Provider business mailing address

1823 E 215TH ST
CARSON CA
90745-1815
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-8672
  • Fax:
Mailing address:
  • Phone: 562-630-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95378407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: