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NPI Code Detail

MEDICARE: JOHN IYENGUNMWENA

MEDICARE: JOHN IYENGUNMWENA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1902176084
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN IYENGUNMWENA
Provider Business Mailing Address
First Line : 817 N DIXIE HWY
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33060-5621
Country : US
Telephone Number : 954-785-8285
Fax Number :
Provider Business Practice Location Address
First Line : 817 N DIXIE HWY
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33060-5621
Country : US
Telephone Number : 954-785-8285
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2012
Last Update Date : 01/06/2012

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