Provider Demographics
NPI:1902169196
Name:IKPEAMAEZE, LILIAN ONYINYE
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:ONYINYE
Last Name:IKPEAMAEZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 C ST
Mailing Address - Street 2:212
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5100
Mailing Address - Country:US
Mailing Address - Phone:619-238-4180
Mailing Address - Fax:619-238-4245
Practice Address - Street 1:1225 W 190TH ST STE 280
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4305
Practice Address - Country:US
Practice Address - Phone:877-515-8113
Practice Address - Fax:877-538-2102
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA788779163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse