Provider Demographics
NPI:1972522167
Name:AGWAMBA, UGOCHI ROSELINE (RN)
Entity type:Individual
Prefix:MRS
First Name:UGOCHI
Middle Name:ROSELINE
Last Name:AGWAMBA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S INGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-3205
Mailing Address - Country:US
Mailing Address - Phone:310-673-3304
Mailing Address - Fax:310-673-3156
Practice Address - Street 1:805 S INGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3205
Practice Address - Country:US
Practice Address - Phone:310-673-3304
Practice Address - Fax:310-673-3156
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44438332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44438Medicaid