Healthcare Provider Details

I. General information

NPI: 1487366803
Provider Name (Legal Business Name): UZODINMA EZEIBEKWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E DEL AMO BLVD APT 101
CARSON CA
90745-3817
US

IV. Provider business mailing address

315 E DEL AMO BLVD APT 101
CARSON CA
90745-3817
US

V. Phone/Fax

Practice location:
  • Phone: 424-489-4763
  • Fax:
Mailing address:
  • Phone: 424-489-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number01210047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: