Provider Demographics
NPI:1699107847
Name:NDUBUEZE, ENYICHI NATHANIEL (SFIDC)
Entity type:Individual
Prefix:MR
First Name:ENYICHI
Middle Name:NATHANIEL
Last Name:NDUBUEZE
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 GRETCHEN RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6258
Mailing Address - Country:US
Mailing Address - Phone:773-679-9080
Mailing Address - Fax:
Practice Address - Street 1:660 GRETCHEN RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6258
Practice Address - Country:US
Practice Address - Phone:773-679-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman