Provider Demographics
NPI:1801087457
Name:UGWUMBA, CHARLES (LVN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:UGWUMBA
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 1:16695 ARROYO PARK DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-2131
Mailing Address - Country:US
Mailing Address - Phone:951-295-1883
Mailing Address - Fax:951-243-9390
Practice Address - Street 1:31139 PEREGRINE WAY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-9806
Practice Address - Country:US
Practice Address - Phone:714-448-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 198305164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse