Provider Demographics
NPI:1124841556
Name:LEKWAUWA, ELENDU EME
Entity type:Individual
Prefix:MR
First Name:ELENDU
Middle Name:EME
Last Name:LEKWAUWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31992
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94604-7992
Mailing Address - Country:US
Mailing Address - Phone:925-451-7866
Mailing Address - Fax:
Practice Address - Street 1:15200 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1013
Practice Address - Country:US
Practice Address - Phone:510-352-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250109164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse