Healthcare Provider Details

I. General information

NPI: 1700719549
Provider Name (Legal Business Name): TONNA U NWANERI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 OCEANSIDE BLVD STE 159-1217
OCEANSIDE CA
92056-6005
US

IV. Provider business mailing address

4140 OCEANSIDE BLVD STE 1591217
OCEANSIDE CA
92056-6005
US

V. Phone/Fax

Practice location:
  • Phone: 713-281-6391
  • Fax:
Mailing address:
  • Phone: 713-281-6391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1102X
TaxonomyMilitary Outpatient Operational (Transportable) Component Clinic/Center
License Number1619439178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: