Provider Demographics
NPI:1457636524
Name:EMENOGU, ETHEL IHEDINANWA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:IHEDINANWA
Last Name:EMENOGU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 W 134TH PL
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-1523
Mailing Address - Country:US
Mailing Address - Phone:213-427-4000
Mailing Address - Fax:213-427-4008
Practice Address - Street 1:3727 W 6TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5108
Practice Address - Country:US
Practice Address - Phone:213-427-4000
Practice Address - Fax:213-427-4008
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily