Healthcare Provider Details

I. General information

NPI: 1225913130
Provider Name (Legal Business Name): CHIDIEBERE EKENM OKOH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

V. Phone/Fax

Practice location:
  • Phone: 916-537-5000
  • Fax:
Mailing address:
  • Phone: 916-537-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number34063
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: