Provider Demographics
NPI:1215365408
Name:EFUETNGU, ERIC ALEMNJI (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ALEMNJI
Last Name:EFUETNGU
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N D ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1715
Mailing Address - Country:US
Mailing Address - Phone:951-318-5395
Mailing Address - Fax:
Practice Address - Street 1:255 N D ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1715
Practice Address - Country:US
Practice Address - Phone:951-318-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAME3021944OtherDEA