Provider Demographics
NPI:1225209836
Name:ILOUNO, BENEDICTA NGOZI (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:BENEDICTA
Middle Name:NGOZI
Last Name:ILOUNO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1009 FERNREST DR
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1517
Mailing Address - Country:US
Mailing Address - Phone:310-627-5850
Mailing Address - Fax:310-627-5855
Practice Address - Street 1:121 S LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3423
Practice Address - Country:US
Practice Address - Phone:310-627-5850
Practice Address - Fax:310-532-7888
Is Sole Proprietor?:No
Enumeration Date:2008-03-23
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14620363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health