Healthcare Provider Details

I. General information

NPI: 1427634120
Provider Name (Legal Business Name): IJEOMA PEACE NWACHUKWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 SERRANO DR APT 6F
SAN FRANCISCO CA
94132-2268
US

IV. Provider business mailing address

405 SERRANO DR APT 6F
SAN FRANCISCO CA
94132-2268
US

V. Phone/Fax

Practice location:
  • Phone: 415-405-5098
  • Fax:
Mailing address:
  • Phone: 415-405-5098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number01151068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: