MEDICARE: EVELYN UGONNA EJINAKA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	95392956	CA

General Provider Information

NPI Number	:	1023713161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN UGONNA EJINAKA RN

Provider Business Mailing Address
First Line	:	7248 PRELUDE WAY
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-5089
Country	:	US
Telephone Number	:	310-600-7844
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 E COOLEY DR
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-3905
Country	:	US
Telephone Number	:	909-458-1350
Fax Number	:	909-580-3705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	06/09/2026

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