Provider Demographics
NPI:1447423488
Name:NWAFOR-ANENE, VICTORIA NGOZI (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:NGOZI
Last Name:NWAFOR-ANENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:NGOZI
Other - Last Name:ANENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1509 CHEYENE ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4824
Mailing Address - Country:US
Mailing Address - Phone:909-798-4424
Mailing Address - Fax:
Practice Address - Street 1:1509 CHEYENE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4824
Practice Address - Country:US
Practice Address - Phone:909-798-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist