Provider Demographics
NPI:1114899010
Name:OGBUJI, EZENWANYI
Entity type:Individual
Prefix:
First Name:EZENWANYI
Middle Name:
Last Name:OGBUJI
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 1:19438 HILLFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2660
Mailing Address - Country:US
Mailing Address - Phone:424-221-4884
Mailing Address - Fax:
Practice Address - Street 1:19438 HILLFORD AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-2660
Practice Address - Country:US
Practice Address - Phone:424-221-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95037042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty