Provider Demographics
NPI:1366304701
Name:EBUNE, EKOLE JOYCE M
Entity type:Individual
Prefix:
First Name:EKOLE
Middle Name:JOYCE M
Last Name:EBUNE
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 1:1483 ORTEGA ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3563
Mailing Address - Country:US
Mailing Address - Phone:405-662-4667
Mailing Address - Fax:
Practice Address - Street 1:1483 ORTEGA ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3563
Practice Address - Country:US
Practice Address - Phone:405-662-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily