Healthcare Provider Details

I. General information

NPI: 1043464837
Provider Name (Legal Business Name): CHIAGOZIEM IGWEZE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11669 GAYVIEW DR
LA MIRADA CA
90638-1107
US

IV. Provider business mailing address

11669 GAYVIEW DR
LA MIRADA CA
90638-1107
US

V. Phone/Fax

Practice location:
  • Phone: 562-903-0683
  • Fax:
Mailing address:
  • Phone: 562-903-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number646768
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: