Provider Demographics
NPI:1235311648
Name:ONYEJEKWE, JUSTIN UZOMA (LICENSE VOCATIONAL N)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:UZOMA
Last Name:ONYEJEKWE
Suffix:
Gender:M
Credentials:LICENSE VOCATIONAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15514 LEAHY AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706
Mailing Address - Country:US
Mailing Address - Phone:323-791-8617
Mailing Address - Fax:562-461-7881
Practice Address - Street 1:15514 LEAHY AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706
Practice Address - Country:US
Practice Address - Phone:323-791-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN203821164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN003230OtherHEALTH SERVICES
CARVN003230OtherHEALTH SERVICES