Healthcare Provider Details

I. General information

NPI: 1225209836
Provider Name (Legal Business Name): BENEDICTA NGOZI ILOUNO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2008
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

IV. Provider business mailing address

1009 FERNREST DR
HARBOR CITY CA
90710-1517
US

V. Phone/Fax

Practice location:
  • Phone: 310-627-5850
  • Fax: 310-532-7888
Mailing address:
  • Phone: 310-627-5850
  • Fax: 310-627-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number14620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: