Provider Demographics
NPI:1922696152
Name:NKWOCHA, ONYEMA G (ADMINISTRATOR)
Entity Type:Individual
Prefix:MR
First Name:ONYEMA
Middle Name:G
Last Name:NKWOCHA
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:MRS
Other - First Name:AUGUSTA
Other - Middle Name:
Other - Last Name:NKWOCHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AG TRANSPORTNONEMERG
Mailing Address - Street 1:3829 WILD PALMS DRIVE MODESTO
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-5605
Mailing Address - Country:US
Mailing Address - Phone:209-567-2766
Mailing Address - Fax:209-567-2766
Practice Address - Street 1:3829 WILD PALMS DRIVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-567-2766
Practice Address - Fax:209-567-2766
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)