Provider Demographics
NPI:1225186133
Name:ADIGWE-MOZIA, MARTHA N (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:N
Last Name:ADIGWE-MOZIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:N
Other - Last Name:MOZIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:14150 GRANT ST
Mailing Address - Street 2:SUITE 78
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9114
Mailing Address - Country:US
Mailing Address - Phone:310-539-5722
Mailing Address - Fax:
Practice Address - Street 1:40 E MINARETS AVE
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:CA
Practice Address - Zip Code:93650-1239
Practice Address - Country:US
Practice Address - Phone:559-436-0482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11282363LP0808X, 363L00000X
CANP11282363L00000X
CAG1112004363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADU4034-P01508618OtherRAILROAD MEDICARE
CAEFF. 6/16/15Medicaid
CAEFF. 6/16/15Medicaid
CACA157290-EFF 6/8/15Medicare UPIN