Individual provider Active NPI

Winifred C Ezenwa, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Downey, CA
National Provider Identifier
1265995260
Registry record updated Apr 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F11180567 Issued in CA
Practice address
11938 Paramount Blvd
Downey, CA 90242-2306
Phone
(562) 923-6060
NPI assigned
Apr 8, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F11180567 CA Primary

Addresses

Primary practice location

11938 Paramount Blvd
Downey, CA 90242-2306

Mailing address

16133 S Vermont Ave Unit 17
Gardena, CA 90247-4986
Phone (310) 953-7004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
F11180567CAMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554681600000",
    "number": "1265995260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16133 S VERMONT AVE UNIT 17",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902474986",
            "telephone_number": "310-953-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11938 PARAMOUNT BLVD",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902422306",
            "telephone_number": "562-923-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZENWA",
        "first_name": "WINIFRED",
        "middle_name": "C",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-08",
        "last_updated": "2019-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "F11180567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downey, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.