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General NPI Number Information
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NPI Number | 1154870988
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Entity Type | Individual
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Provider Name | MRS. NKIRUKA IFEDIBA
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Gender | Female
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 826 GLENWAY DR
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City | INGLEWOOD
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State | CA
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Zip | 90302-2711
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Country | US
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Telephone | 310-308-4094
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Fax | 310-673-1900
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Provider Business Mailing Address
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Address Line | 826 GLENWAY DR
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City | INGLEWOOD
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State | CA
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Zip | 90302-2711
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Country | US
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Telephone | 310-308-4094
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Fax | 310-673-1900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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