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General NPI Number Information
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NPI Number | 1174827125
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Entity Type | Organization
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Legal Business Name | ODOCHI NWAGWU MD INC
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 15095 AMARGOSA RD SUITE 280
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City | VICTORVILLE
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State | CA
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Zip | 92394-1879
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Country | US
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Telephone | 760-952-9100
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Fax | 760-952-9228
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Provider Business Mailing Address
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Address Line | 11678 RANCHO RD
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City | ADELANTO
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State | CA
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Zip | 92301-2700
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Country | US
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Telephone | 760-246-9555
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Fax | 760-246-9115
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Authorized Official
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Title or Position | CEO
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Name | DR. ODOCHI N NWAGWU
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Credential | M.D.
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Telephone | 760-403-5571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18372
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A84056
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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