Izunna Vincent Ewudo, DNP, FNP-C, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95004185 Issued in CA

Practice address

13400 Washington Blvd Ste 105
Marina del Rey, CA 90292-5632

Phone

(310) 200-8957

NPI assigned

May 4, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1073653630
  Medicare reassignment NPD
• St. Johns Community Health

  • Community Health Clinic/Center
  • Los Angeles, CA
  • NPI 1073363768
  NPD
• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1861893844
  NPD
• Neuro Wellness Spa, a Medical PC

  • Psychiatry Physician
  • Manhattan Beach, CA
  • NPI 1003394149
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1255786646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13400 WASHINGTON BLVD STE 105",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925632",
            "telephone_number": "310-200-8957",
            "fax_number": "310-564-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13400 WASHINGTON BLVD STE 105",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925632",
            "telephone_number": "310-200-8957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWUDO",
        "first_name": "IZUNNA",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP-C, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-04",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95004185",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95004185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric J. Klostermann, D.P.M., a Professional Corporation
• Esse Care Surgery California PC
• Carmely Estrella, PH.D., LCSW
• Brian Keith Estwick, MD
• Etie Moghissi, MD,Inc
• Expanse Wellness Acupuncture and Physical Therapy
• Eyes of the Marina Optometry
• Alejandro Christian Fajardo II
• Kambiz Farbakhsh, MD
• Farhad Sigari MD Facs PC

• Psychiatric/Mental Health Nurse Practitioner in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.