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General NPI Number Information
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NPI Number | 1932683240
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Entity Type | Individual
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Provider Name | CHIOMA AGU
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Gender | Female
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 12021 WILMINGTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90059-3019
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Country | US
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Telephone | 424-454-6042
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Fax |
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Provider Business Mailing Address
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Address Line | 11200 LUCAS ST
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City | CERRITOS
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State | CA
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Zip | 90703-1626
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Country | US
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Telephone | 562-578-2548
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95036853
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95058245
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License Number State | CA
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