Healthcare Provider Details

I. General information

NPI: 1306054879
Provider Name (Legal Business Name): TOCHI EUNICE EZENWUGO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23370 ROAD 22 CENTRAL CALIFORNIA WOMENS FACILITY
CHOWCHILLA CA
93610
US

IV. Provider business mailing address

625 E KEATS AVE
FRESNO CA
93710-7000
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-5531
  • Fax:
Mailing address:
  • Phone: 559-226-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number509831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: