Healthcare Provider Details

I. General information

NPI: 1255473625
Provider Name (Legal Business Name): HILARY CHUKWUDINMA NWOSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 S MAIN ST
LOS ANGELES CA
90003-1215
US

IV. Provider business mailing address

5757 S STAPLES ST APT. # 4109
CORPUS CHRISTI TX
78413-3732
US

V. Phone/Fax

Practice location:
  • Phone: 323-846-4312
  • Fax:
Mailing address:
  • Phone: 361-723-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036150585
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberA84336
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.207300
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: