Provider Demographics
NPI:1598382921
Name:ILOKA, AGATHA NDUDI (FNP)
Entity type:Individual
Prefix:MRS
First Name:AGATHA
Middle Name:NDUDI
Last Name:ILOKA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4515
Mailing Address - Country:US
Mailing Address - Phone:562-437-1888
Mailing Address - Fax:562-491-1200
Practice Address - Street 1:934 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4515
Practice Address - Country:US
Practice Address - Phone:562-437-1888
Practice Address - Fax:562-491-1200
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA707827163WC0200X
CA95017561363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA707827OtherACADEMIC WORK