Healthcare Provider Details

I. General information

NPI: 1023713161
Provider Name (Legal Business Name): EVELYN UGONNA EJINAKA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E COOLEY DR
COLTON CA
92324-3905
US

IV. Provider business mailing address

7248 PRELUDE WAY
FONTANA CA
92336-5089
US

V. Phone/Fax

Practice location:
  • Phone: 909-458-1350
  • Fax: 909-580-3705
Mailing address:
  • Phone: 310-600-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95392956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: