Healthcare Provider Details

I. General information

NPI: 1013868330
Provider Name (Legal Business Name): NGOZI ANITA NWABUZOH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 LEWIS ST
SAN DIEGO CA
92103-2122
US

IV. Provider business mailing address

3535 LEBON DR APT 5414
SAN DIEGO CA
92122-6405
US

V. Phone/Fax

Practice location:
  • Phone: 619-821-9872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: