Healthcare Provider Details

I. General information

NPI: 1760176853
Provider Name (Legal Business Name): GEORGE UWAKWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34077 PASEO PADRE PKWY APT 107
FREMONT CA
94555-2354
US

IV. Provider business mailing address

34077 PASEO PADRE PKWY APT 107
FREMONT CA
94555-2354
US

V. Phone/Fax

Practice location:
  • Phone: 141-567-8071
  • Fax:
Mailing address:
  • Phone: 141-567-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4720863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: