Healthcare Provider Details

I. General information

NPI: 1093846453
Provider Name (Legal Business Name): DONALD IWUAGWU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 W AVENUE M
QUARTZ HILL CA
93536-3010
US

IV. Provider business mailing address

5021 W AVENUE M
QUARTZ HILL CA
93536-3010
US

V. Phone/Fax

Practice location:
  • Phone: 661-718-3870
  • Fax: 661-718-3970
Mailing address:
  • Phone: 661-718-3870
  • Fax: 661-718-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number47180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: