Provider Demographics
NPI:1932330768
Name:ONYEACHONAM, EZIJE (NP)
Entity Type:Individual
Prefix:
First Name:EZIJE
Middle Name:
Last Name:ONYEACHONAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N WATERMAN AVE
Mailing Address - Street 2:DEPT OF CATH LAB
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4836
Mailing Address - Country:US
Mailing Address - Phone:909-883-8711
Mailing Address - Fax:909-881-4534
Practice Address - Street 1:2101 N WATERMAN AVE
Practice Address - Street 2:DEPT OF CATH LAB
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4836
Practice Address - Country:US
Practice Address - Phone:909-883-8711
Practice Address - Fax:909-881-4534
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA17158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner