Organization
COMMUNITY WELLNESS MEDICAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE N EKEJIUBA NP (OWNER)
(310) 722-5146
Entity
Organization
Contact information
Practice address
1218 S INGLEWOOD AVE, INGLEWOOD, CA 90301-3649
(310) 722-5146
Mailing address
1458 E GLADWICK ST, CARSON, CA 90746-3804
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
07/25/2019
Last updated
08/14/2019
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