Provider Demographics
NPI:1619959301
Name:ALA-NGWA AMERICAN ENT.INC.
Entity Type:Organization
Organization Name:ALA-NGWA AMERICAN ENT.INC.
Other - Org Name:ADELANTO MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ONYENKWERE
Authorized Official - Middle Name:OKWU
Authorized Official - Last Name:OKWANDU
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHD
Authorized Official - Phone:760-246-9555
Mailing Address - Street 1:11678 RANCHO RD
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-2700
Mailing Address - Country:US
Mailing Address - Phone:760-246-9555
Mailing Address - Fax:760-246-9115
Practice Address - Street 1:11678 RANCHO RD
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-2700
Practice Address - Country:US
Practice Address - Phone:760-246-9555
Practice Address - Fax:760-246-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G770491Medicaid