Provider Demographics
NPI:1124576483
Name:ACHUFUSI, OGECHUKWU
Entity Type:Individual
Prefix:
First Name:OGECHUKWU
Middle Name:
Last Name:ACHUFUSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6177 EAGLEMONT DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5817
Mailing Address - Country:US
Mailing Address - Phone:310-404-5961
Mailing Address - Fax:
Practice Address - Street 1:6177 EAGLEMONT DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5817
Practice Address - Country:US
Practice Address - Phone:310-404-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse