Provider Demographics
NPI:1043499528
Name:CHUKWUDI NNAMDI EZEUNALA
Entity Type:Organization
Organization Name:CHUKWUDI NNAMDI EZEUNALA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKWUDI
Authorized Official - Middle Name:NNAMDI
Authorized Official - Last Name:EZEUNALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-752-3031
Mailing Address - Street 1:1957 W MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-2924
Mailing Address - Country:US
Mailing Address - Phone:323-752-3031
Mailing Address - Fax:323-752-3132
Practice Address - Street 1:1957 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-2924
Practice Address - Country:US
Practice Address - Phone:323-752-3031
Practice Address - Fax:323-752-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43755332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies