Provider Demographics
NPI:1922119155
Name:NWABUNWANNE, FRANK CHINEDU
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:CHINEDU
Last Name:NWABUNWANNE
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 1:2007 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3506
Mailing Address - Country:US
Mailing Address - Phone:213-413-0220
Mailing Address - Fax:
Practice Address - Street 1:2007 WILSHIRE BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3506
Practice Address - Country:US
Practice Address - Phone:213-413-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103837332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5422020001Medicare ID - Type Unspecified