Provider Demographics
NPI:1497258669
Name:CHRISTOPHER, NGOZI CHIDIUTO
Entity type:Individual
Prefix:
First Name:NGOZI
Middle Name:CHIDIUTO
Last Name:CHRISTOPHER
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 1:40555 CALIFORNIA OAKS RD
Mailing Address - Street 2:STE 111
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:951-502-4879
Mailing Address - Fax:936-261-7143
Practice Address - Street 1:40555 CALIFORNIA OAKS RD STE 111
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5723
Practice Address - Country:US
Practice Address - Phone:951-502-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007868363LF0000X
CANP95007869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily