Provider Demographics
NPI:1447962485
Name:ANUGWOM, ONYINYECHI (NP)
Entity type:Individual
Prefix:
First Name:ONYINYECHI
Middle Name:
Last Name:ANUGWOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 W MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-8018
Mailing Address - Country:US
Mailing Address - Phone:310-259-0540
Mailing Address - Fax:
Practice Address - Street 1:2589 W MALLARD LN
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-8018
Practice Address - Country:US
Practice Address - Phone:310-259-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020026363L00000X
103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)