Healthcare Provider Details

I. General information

NPI: 1760936801
Provider Name (Legal Business Name): NWANKAEGO NWANDEI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 RIVERSIDE DR SUITE 606
SHERMAN OAKS CA
91423-2430
US

IV. Provider business mailing address

2209 E BASELINE RD STE 300-171
CLAREMONT CA
91711-7901
US

V. Phone/Fax

Practice location:
  • Phone: 310-871-0670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA53760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: