Provider Demographics
NPI:1952746174
Name:AMALU, PRISCILLA NGOZI (NP)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:NGOZI
Last Name:AMALU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12319 GLEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1925
Mailing Address - Country:US
Mailing Address - Phone:562-965-9897
Mailing Address - Fax:
Practice Address - Street 1:12319 GLEN CREEK RD
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1925
Practice Address - Country:US
Practice Address - Phone:562-965-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 21636363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health