Individual
KENNETH EZENWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
17467 HONEY MAPLE ST, CANYON COUNTRY, CA 91387-6870
(661) 212-5273
Mailing address
17467 HONEY MAPLE ST, CANYON COUNTRY, CA 91387-6870
(661) 212-5273
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
95080178
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95080178
CA
Other
Enumeration date
04/08/2019
Last updated
02/08/2022
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