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General NPI Number Information
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NPI Number | 1184710121
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Entity Type | Individual
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Provider Name | NKOLI ANIGBOGU MD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 1050 KENDALL DR STE F
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4125
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Country | US
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Telephone | 909-352-6655
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Fax | 909-352-6770
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Provider Business Mailing Address
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Address Line | 3130 N COUNTY ROAD 25A
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City | TROY
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State | OH
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Zip | 45373-1337
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Country | US
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Telephone | 937-440-4466
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Fax | 937-440-4470
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C170662
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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 | 01084495A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35-0803901-A
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35.083901
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License Number State | OH
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