Provider Demographics
NPI:1164236139
Name:ONWUKA, AFONNE COMFORT
Entity type:Individual
Prefix:
First Name:AFONNE
Middle Name:COMFORT
Last Name:ONWUKA
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 1:2343 MCMACKIN DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8681
Mailing Address - Country:US
Mailing Address - Phone:909-486-5293
Mailing Address - Fax:
Practice Address - Street 1:2343 MCMACKIN DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-8681
Practice Address - Country:US
Practice Address - Phone:909-486-5293
Practice Address - Fax:909-380-6257
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033433363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health