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General NPI Number Information
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NPI Number | 1710180260
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Entity Type | Individual
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Provider Name | CECILIA O AMAJOYI AGUNENYE PA
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 8160 DAY CREEK BLVD UNIT 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-9329
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Country | US
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Telephone | 909-825-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 1068 CRESTHAVEN RD 300
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City | MEMPHIS
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State | TN
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Zip | 38119-0809
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Country | US
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Telephone | 901-683-0024
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA895
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA55699
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License Number State | CA
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