Healthcare Provider Details

I. General information

NPI: 1932016631
Provider Name (Legal Business Name): EOS NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 CARFAX AVE
LAKEWOOD CA
90713-1253
US

IV. Provider business mailing address

5603 CARFAX AVE
LAKEWOOD CA
90713-1253
US

V. Phone/Fax

Practice location:
  • Phone: 562-378-3798
  • Fax: 562-512-4871
Mailing address:
  • Phone: 562-378-3798
  • Fax: 562-512-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK ANWULI AWANYAI JR.
Title or Position: PRESIDENT
Credential: PMHNP-BC
Phone: 562-378-3798