Healthcare Provider Details

I. General information

NPI: 1750651675
Provider Name (Legal Business Name): VERONICA NKESE NSA EYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E FOOTHILL BLVD STE 102
ARCADIA CA
91006-2361
US

IV. Provider business mailing address

41 E FOOTHILL BLVD STE 102
ARCADIA CA
91006-2361
US

V. Phone/Fax

Practice location:
  • Phone: 626-701-4249
  • Fax: 626-737-6034
Mailing address:
  • Phone: 626-701-4249
  • Fax: 626-737-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: