Provider Demographics
NPI:1487366803
Name:EZEIBEKWE, UZODINMA
Entity type:Individual
Prefix:
First Name:UZODINMA
Middle Name:
Last Name:EZEIBEKWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E DEL AMO BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3817
Mailing Address - Country:US
Mailing Address - Phone:424-489-4763
Mailing Address - Fax:
Practice Address - Street 1:315 E DEL AMO BLVD APT 101
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3817
Practice Address - Country:US
Practice Address - Phone:424-489-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01210047376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide