Ethel Ntom Odimegwu, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95013976 Issued in CA

Practice address

3633 Camino del Rio S Ste 300
San Diego, CA 92108-4014

Phone

(619) 287-9730

Fax

(619) 287-4516

NPI assigned

Feb 19, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ethel.odimegwu.1@10718.direct.athenahealth.com
• Direct secure messaging: ethel.odimegwu.2@10718.direct.athenahealth.com

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.

• High Desert Limb Salvage Institute Podiatrist Corp

  • Podiatric Clinic/Center
  • Apple Valley, CA
  • NPI 1588132062
  NPD (past)

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756857600000",
    "number": "1952934739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15625 MESA VERDE DR",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925554220",
            "telephone_number": "909-565-2622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3633 CAMINO DEL RIO S STE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084014",
            "telephone_number": "619-287-9730",
            "fax_number": "619-287-4516"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "441 W State St",
            "address_purpose": "LOCATION",
            "city": "El Centro",
            "state": "CA",
            "postal_code": "922433021",
            "country_code": "US",
            "telephone_number": "760-337-2949",
            "fax_number": "760-337-5698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODIMEGWU",
        "first_name": "ETHEL",
        "middle_name": "NTOM",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-19",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95013976",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95013976",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Mackenzie Odell
• Marcella Raquel Oden, PT, DPT, DACM, L.AC.
• Justin Oderkirk
• Lyssa Wallace Odette, OD
• Ashika Odhav, MD
• Mazen Faris Odish, M.D.
• Neven Odish
• Alyssa Emilee Odneal, PA
• Jeffrey Alan Odnert, DACM, L. AC
• Russ Odom, CMT, CMMP

• Family Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2025; 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.