Provider Demographics
NPI:1821563073
Name:OZOR, AMAECHI GEORGE (FNP)
Entity type:Individual
Prefix:
First Name:AMAECHI
Middle Name:GEORGE
Last Name:OZOR
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 FLOYD AVE APT 364
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8765
Mailing Address - Country:US
Mailing Address - Phone:949-514-8188
Mailing Address - Fax:
Practice Address - Street 1:1620 N CARPENTER RD STE D46
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1161
Practice Address - Country:US
Practice Address - Phone:949-514-8188
Practice Address - Fax:209-492-7119
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95051033163W00000X
CA95010238363LF0000X, 163WP0000X, 261QP3300X, 363LA2100X, 363LP2300X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health