Individual
ETHEL NTOM ODIMEGWU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
3633 CAMINO DEL RIO S STE 300, SAN DIEGO, CA 92108-4014
(619) 287-9730
(619) 287-4516
Mailing address
15625 MESA VERDE DR, MORENO VALLEY, CA 92555-4220
(909) 565-2622
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95013976
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
95013976
CA
Other
Enumeration date
02/19/2020
Last updated
09/03/2025
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