Provider Demographics
NPI:1255786646
Name:EWUDO, IZUNNA VINCENT (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:IZUNNA
Middle Name:VINCENT
Last Name:EWUDO
Suffix:
Gender:M
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 WASHINGTON BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5632
Mailing Address - Country:US
Mailing Address - Phone:310-200-8957
Mailing Address - Fax:310-564-2295
Practice Address - Street 1:13400 WASHINGTON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5632
Practice Address - Country:US
Practice Address - Phone:310-200-8957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004185363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily