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General NPI Number Information
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NPI Number | 1265995260
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Entity Type | Individual
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Provider Name | WINIFRED C EZENWA NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 11938 PARAMOUNT BLVD
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City | DOWNEY
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State | CA
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Zip | 90242-2306
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Country | US
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Telephone | 562-923-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 16133 S VERMONT AVE UNIT 17
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City | GARDENA
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State | CA
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Zip | 90247-4986
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Country | US
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Telephone | 310-953-7004
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F11180567
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License Number State | CA
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