Provider Demographics
NPI:1194360123
Name:UGBANA, CHIBUOGWU E (RN,MSN)
Entity Type:Individual
Prefix:
First Name:CHIBUOGWU
Middle Name:E
Last Name:UGBANA
Suffix:
Gender:F
Credentials:RN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 ARNOLD CT
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-4707
Mailing Address - Country:US
Mailing Address - Phone:323-503-8569
Mailing Address - Fax:
Practice Address - Street 1:3116 ARNOLD CT
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-4707
Practice Address - Country:US
Practice Address - Phone:323-503-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023398163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
XXXXXXXXXXXXXXXXDOtherNOT APPLICABLE