Healthcare Provider Details

I. General information

NPI: 1891438966
Provider Name (Legal Business Name): ANTOINETTE IJEOMA GNONA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANTOINETTE ALUGBUE

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 10/01/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 LAGUNA BLVD
ELK GROVE CA
95758
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-454-6850
  • Fax: 916-454-6852
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA188935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: