Individual provider Active NPI

Ezekiel Osondo Nwaigwe, RDN

  • Registered Dietitian
  • San Diego, CA
National Provider Identifier
1467110296
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
86169824 Issued in IL
Practice address
6775 Alvarado Rd Unit 9
San Diego, CA 92120-5211
Phone
(760) 402-3612
NPI assigned
Nov 29, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 86169824 IL Primary

Addresses

Primary practice location

6775 Alvarado Rd Unit 9
San Diego, CA 92120-5211

Mailing address

PO Box 431305
San Diego, CA 92143-1305
Phone (760) 402-3612

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
86169824ILMDRegistered Dietitian

NPI Registry JSON

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

{
    "created_epoch": "1638144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1467110296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 431305",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921431305",
            "telephone_number": "760-402-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6775 ALVARADO RD UNIT 9",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205211",
            "telephone_number": "760-402-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWAIGWE",
        "first_name": "EZEKIEL",
        "middle_name": "OSONDO",
        "credential": "RDN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-29",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "86169824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; 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.