Provider Demographics
NPI:1700489770
Name:OMONUA, DAVID EHIZIJE
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EHIZIJE
Last Name:OMONUA
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 1:85 RAMONA EXPY STE 1
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7014
Mailing Address - Country:US
Mailing Address - Phone:951-349-4195
Mailing Address - Fax:
Practice Address - Street 1:85 RAMONA EXPY STE 1
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7014
Practice Address - Country:US
Practice Address - Phone:951-349-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW974221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical