Provider Demographics
NPI:1679767701
Name:ONUAGULUCHI, VICTOR NWACHUKWU (CRNA)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:NWACHUKWU
Last Name:ONUAGULUCHI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9741 ELMHURST DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-7112
Mailing Address - Country:US
Mailing Address - Phone:559-284-8021
Mailing Address - Fax:
Practice Address - Street 1:2615 CESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-869-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489118163W00000X
CANA 2443367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGA501YMedicare PIN
CACD4582Medicare PIN
CAZZZ34009ZMedicare PIN
CAP01214567Medicare PIN