Individual
EZINWANYI GIFT MARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9990 COUNTY FARM RD, RIVERSIDE, CA 92503-3542
(951) 358-3610
Mailing address
8237 HIGHRIDGE PL, RANCHO CUCAMONGA, CA 91730-3170
(626) 215-4361
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95023172
CA
Other
Enumeration date
05/10/2023
Last updated
05/10/2023
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