Healthcare Provider Details

I. General information

NPI: 1063107514
Provider Name (Legal Business Name): CARMEN-ROSE NDUKWE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 N ELM ST ESCONDIDO
ESCONDIDO CA
92025
US

IV. Provider business mailing address

UHS SOCAL MEDICAL EDUCATION CONSORTIUM 31700 TEMECULA PARKWAY, PARKWAY SUITES # 1- GMETEMECULA
TEMECULA CA
92592
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: