MEDICARE: EDWARD AGUNANNE ALOZIE

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	225400000X	Rehabilitation Practitioner	374603836	CA

General Provider Information

NPI Number	:	1831676667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD AGUNANNE ALOZIE

Provider Business Mailing Address
First Line	:	966 BOLLENBACHER ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-1833
Country	:	US
Telephone Number	:	619-642-0212
Fax Number	:	619-642-0212

Provider Business Practice Location Address
First Line	:	966 BOLLENBACHER ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-1833
Country	:	US
Telephone Number	:	619-642-0212
Fax Number	:	619-642-0212

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

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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