Provider Demographics
NPI:1558130229
Name:MOMODU, AUGUSTA E
Entity Type:Individual
Prefix:MS
First Name:AUGUSTA
Middle Name:E
Last Name:MOMODU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11466 LYLE LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-6244
Mailing Address - Country:US
Mailing Address - Phone:305-297-1328
Mailing Address - Fax:
Practice Address - Street 1:11466 LYLE LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-6244
Practice Address - Country:US
Practice Address - Phone:305-297-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95211516163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse