Provider Demographics
NPI:1619280542
Name:EGBUZIEM, CATHERINE C
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:EGBUZIEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:C
Other - Last Name:EGBUZIEMALTRAIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:4121 BROCKTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3442
Mailing Address - Country:US
Mailing Address - Phone:951-778-0032
Mailing Address - Fax:951-778-0051
Practice Address - Street 1:4121 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3442
Practice Address - Country:US
Practice Address - Phone:951-778-0332
Practice Address - Fax:951-778-0051
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA573250163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse