Healthcare Provider Details

I. General information

NPI: 1396257382
Provider Name (Legal Business Name): IJEOMA H EZEMONYE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5831 FIRESTONE BLVD STE E
SOUTH GATE CA
90280-3718
US

IV. Provider business mailing address

5831 FIRESTONE BLVD STE E
SOUTH GATE CA
90280-3718
US

V. Phone/Fax

Practice location:
  • Phone: 562-806-7545
  • Fax:
Mailing address:
  • Phone: 562-806-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95007825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: