Provider Demographics
NPI:1659774560
Name:AZUBUIKE, EZIOMA (NP)
Entity Type:Individual
Prefix:MRS
First Name:EZIOMA
Middle Name:
Last Name:AZUBUIKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EZIOMA
Other - Middle Name:
Other - Last Name:NWOKAFOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 W 3RD ST
Mailing Address - Street 2:APT 137
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3005
Mailing Address - Country:US
Mailing Address - Phone:310-782-5409
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:SUITE 400
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001257363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care