1194360123 NPI number — CHIBUOGWU E UGBANA RN,MSN

Table of content: CHIBUOGWU E UGBANA RN,MSN (NPI 1194360123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194360123 NPI number — CHIBUOGWU E UGBANA RN,MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UGBANA
Provider First Name:
CHIBUOGWU
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN,MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194360123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3116 ARNOLD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93933-4707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-503-8569
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3116 ARNOLD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARINA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93933-4707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-503-8569
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0808X , with the licence number:  95023398 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: XXXXXXXXXXXXXXXXD . This is a "NOT APPLICABLE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com