Healthcare Provider Details

I. General information

NPI: 1578210167
Provider Name (Legal Business Name): DARLENE NWAGBUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 ALTA RD # 5400
SAN DIEGO CA
92158-0001
US

IV. Provider business mailing address

446 ALTA RD # 5400
SAN DIEGO CA
92158-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-268-9338
  • Fax:
Mailing address:
  • Phone: 619-268-9338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107926
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: