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General NPI Number Information
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NPI Number | 1780108878
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Entity Type | Individual
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Provider Name | DEVINE NDIKWA
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Gender | Male
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 07/31/2017
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Provider Practice Location Address
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Address Line | 3111 LOS FELIZ BLVD STE 211
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City | LOS ANGELES
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State | CA
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Zip | 90039-1585
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Country | US
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Telephone | 866-227-3310
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Fax | 866-491-1305
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Provider Business Mailing Address
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Address Line | 9440 ROSE ST
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City | BELLFLOWER
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State | CA
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Zip | 90706-6529
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Country | US
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Telephone | 310-995-5620
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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 | 95005666
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License Number State | CA
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