Provider Demographics
NPI:1457516916
Name:NYENKE, ONWUDIWE C
Entity Type:Individual
Prefix:MR
First Name:ONWUDIWE
Middle Name:C
Last Name:NYENKE
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:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90307
Mailing Address - Country:US
Mailing Address - Phone:310-674-5800
Mailing Address - Fax:310-674-5900
Practice Address - Street 1:937 S LA BIEA AVENUE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-674-5800
Practice Address - Fax:310-674-5900
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103151Medicaid
CA103151Medicaid