Provider Demographics
NPI:1669101580
Name:IGBO, CHRISTIANA NEBECHI
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:NEBECHI
Last Name:IGBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 SANTA CHRISTINA AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3291
Mailing Address - Country:US
Mailing Address - Phone:301-573-6729
Mailing Address - Fax:
Practice Address - Street 1:7488 CALZADA DE LA FUENTE, OTAY MESA DETENTION CENTER
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92231
Practice Address - Country:US
Practice Address - Phone:619-671-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily