Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 19661 | CA |
NPI | 1003194416 |
---|---|
Provider Name | Ms. Gloria Ngozi Nwagwu |
First Address | Cypress, CA 90630-3951 |
Second Address | Compton, CA 90220-3110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2011 |
Last Update Date | 28/06/2016 |