Provider Demographics
NPI:1538718598
Name:ASOGU-NWOSU, SOPHIE-CHIZOMA CHINENYE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SOPHIE-CHIZOMA
Middle Name:CHINENYE
Last Name:ASOGU-NWOSU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-1088
Mailing Address - Country:US
Mailing Address - Phone:714-443-4512
Mailing Address - Fax:
Practice Address - Street 1:10441 LAKEWOOD BLVD STE AB
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2744
Practice Address - Country:US
Practice Address - Phone:562-869-1070
Practice Address - Fax:562-286-8777
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty