Basic Information
| Provider Information | |||||||||
| NPI: | 1699002550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EZE | ||||||||
| FirstName: | NWANDO | ||||||||
| MiddleName: | UCHENNA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 BALLARD | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926021682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304000784 | ||||||||
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| Practice Location | |||||||||
| Address1: | 455 S. MAIN STREET | ||||||||
| Address2: | DEPARTMENT OF PEDIATRICS | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149973000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2009 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A103608 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.