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General NPI Number Information
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NPI Number | 1598382921
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Entity Type | Individual
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Provider Name | AGATHA NDUDI ILOKA FNP
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Gender | Female
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 934 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90813-4515
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Country | US
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Telephone | 562-437-1888
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Fax | 562-491-1200
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Provider Business Mailing Address
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Address Line | 934 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90813-4515
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Country | US
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Telephone | 562-437-1888
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Fax | 562-491-1200
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 707827
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95017561
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License Number State | CA
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