Healthcare Provider Details

I. General information

NPI: 1952229437
Provider Name (Legal Business Name): NONSO NDUKA EGWUATU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 S AMPHLETT BLVD STE 215
SAN MATEO CA
94402-2723
US

IV. Provider business mailing address

1776 DE PINA LN
HAYWARD CA
94545-3421
US

V. Phone/Fax

Practice location:
  • Phone: 510-517-3156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: