Individual
MANASSEH C NWAIGWE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1159 S. LORENA ST, LOS ANGELES, CA 90023
(323) 881-6465
(323) 261-8768
Mailing address
P.O. BOX 479, MONTEREY PARK, CA 91754
(323) 881-6465
(323) 261-8768
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A42352
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A425320
—
CA
01
—
AV904Y
PTAN
CA
01
—
AV904Z
MEDICARE PTAN
CA
Enumeration date
04/17/2007
Last updated
12/20/2010
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