Provider Demographics
NPI:1255025342
Name:AJUNWA, MERCILLINA N
Entity type:Individual
Prefix:
First Name:MERCILLINA
Middle Name:N
Last Name:AJUNWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42590 OSLO CIR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8191
Mailing Address - Country:US
Mailing Address - Phone:951-775-7589
Mailing Address - Fax:
Practice Address - Street 1:32350 HEARTH GLEN CT # 1
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-8676
Practice Address - Country:US
Practice Address - Phone:951-775-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576971163WH0200X, 163WW0000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care