Healthcare Provider Details

I. General information

NPI: 1447379615
Provider Name (Legal Business Name): CHEKWUBE ANYANWU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 MOUNTAIN VIEW ST
ALTADENA CA
91001-4925
US

IV. Provider business mailing address

1471 PINEWOOD DR
CORONA CA
92881-0716
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-6793
  • Fax: 626-398-8590
Mailing address:
  • Phone: 951-237-9221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: