MEDICARE: BOKENG ISANGE NWENGELA

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	363LF0000X	Family Nurse Practitioner	95013227	CA

General Provider Information

NPI Number	:	1134737356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOKENG ISANGE NWENGELA

Provider Business Mailing Address
First Line	:	16761 VIEWPOINT LN APT 80
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2637 E CARSON ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90810-1508
Country	:	US
Telephone Number	:	310-933-6450
Fax Number	:

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

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	07/14/2020

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Directions to “ BOKENG ISANGE NWENGELA ” Practice Location

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