Provider Demographics
NPI:1467124107
Name:NGUGI, ERIC N (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:N
Last Name:NGUGI
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 W EMPIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-5004
Mailing Address - Country:US
Mailing Address - Phone:816-258-0038
Mailing Address - Fax:
Practice Address - Street 1:4082 WHITTIER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2559
Practice Address - Country:US
Practice Address - Phone:816-258-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024190363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner