Provider Demographics
NPI:1831676667
Name:ALOZIE, EDWARD AGUNANNE
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:AGUNANNE
Last Name:ALOZIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 BOLLENBACHER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-1833
Mailing Address - Country:US
Mailing Address - Phone:619-642-0212
Mailing Address - Fax:619-642-0212
Practice Address - Street 1:966 BOLLENBACHER ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-1833
Practice Address - Country:US
Practice Address - Phone:619-642-0212
Practice Address - Fax:619-642-0212
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374603836225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner