Provider Demographics
NPI:1619280542
Name:EGBUZIEM, CATHERINE C
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:EGBUZIEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:EGBUZIEMALTRAIDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:7238 PLUM TREE PL
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5717
Mailing Address - Country:US
Mailing Address - Phone:909-214-7327
Mailing Address - Fax:
Practice Address - Street 1:651 N STATE ST STE 5
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-6574
Practice Address - Country:US
Practice Address - Phone:442-347-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA573250163W00000X
CA95014006363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse