Healthcare Provider Details

I. General information

NPI: 1184078099
Provider Name (Legal Business Name): CHIOMA ENWEASOR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2016
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15290 SUMMIT AVE STE B
FONTANA CA
92336-0240
US

IV. Provider business mailing address

15290 SUMMIT AVE STE B
FONTANA CA
92336-0240
US

V. Phone/Fax

Practice location:
  • Phone: 909-225-1900
  • Fax: 909-663-9072
Mailing address:
  • Phone: 909-225-1900
  • Fax: 909-663-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA151014
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA151014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: