Provider Demographics
NPI:1669878104
Name:ENEH, DAMIAN CHUKWUDI (LVN)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:CHUKWUDI
Last Name:ENEH
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 OBISPO AVE APT 260
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2754
Mailing Address - Country:US
Mailing Address - Phone:562-682-4038
Mailing Address - Fax:
Practice Address - Street 1:6655 OBISPO AVE APT 260
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2754
Practice Address - Country:US
Practice Address - Phone:562-682-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 257652164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse