Healthcare Provider Details

I. General information

NPI: 1013598911
Provider Name (Legal Business Name): NWAMAKA NWOSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E COLORADO BLVD STE 600
PASADENA CA
91105-3712
US

IV. Provider business mailing address

8827 1/2 RAMSGATE AVE
LOS ANGELES CA
90045-4609
US

V. Phone/Fax

Practice location:
  • Phone: 844-735-1418
  • Fax:
Mailing address:
  • Phone: 310-882-1205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: