Healthcare Provider Details

I. General information

NPI: 1184960890
Provider Name (Legal Business Name): CHINENYE EGWUONWU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3791 KATELLA AVE STE. 108
LOS ALAMITOS CA
90720-3105
US

IV. Provider business mailing address

3791 KATELLA AVE STE. 108
LOS ALAMITOS CA
90720-3105
US

V. Phone/Fax

Practice location:
  • Phone: 562-431-3521
  • Fax: 562-431-2070
Mailing address:
  • Phone: 562-431-3521
  • Fax: 562-431-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number520986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: