Provider Demographics
NPI:1881094704
Name:IYALOMHE, NWANYIEZE
Entity type:Individual
Prefix:
First Name:NWANYIEZE
Middle Name:
Last Name:IYALOMHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9863 NOVARA LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-6823
Mailing Address - Country:US
Mailing Address - Phone:310-503-5713
Mailing Address - Fax:
Practice Address - Street 1:10101 SLATER AVE
Practice Address - Street 2:SUITE 241
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4714
Practice Address - Country:US
Practice Address - Phone:714-378-2620
Practice Address - Fax:714-378-2631
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical