Provider Demographics
NPI:1194375303
Name:ANULUOHA, ANTHONIA CHIDIMMA
Entity type:Individual
Prefix:
First Name:ANTHONIA
Middle Name:CHIDIMMA
Last Name:ANULUOHA
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 1:3118 REID AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-7413
Mailing Address - Country:US
Mailing Address - Phone:310-621-6111
Mailing Address - Fax:310-838-0967
Practice Address - Street 1:3118 REID AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-7413
Practice Address - Country:US
Practice Address - Phone:310-621-6111
Practice Address - Fax:310-838-0967
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily