Provider Demographics
NPI:1669995494
Name:EBOKA, NGOZI EDITH
Entity type:Individual
Prefix:MRS
First Name:NGOZI
Middle Name:EDITH
Last Name:EBOKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NGOZICHUKWUKA
Other - Middle Name:EDITH
Other - Last Name:OKOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:29833 TWIN LAKES RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-9255
Mailing Address - Country:US
Mailing Address - Phone:909-205-1663
Mailing Address - Fax:
Practice Address - Street 1:29833 TWIN LAKES RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9255
Practice Address - Country:US
Practice Address - Phone:909-205-1663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily