Healthcare Provider Details

I. General information

NPI: 1508244740
Provider Name (Legal Business Name): SEBASTINE EMEKA CHIKEZIE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20111 WADLEY AVE
CARSON CA
90746-3046
US

IV. Provider business mailing address

20111 WADLEY AVE
CARSON CA
90746-3046
US

V. Phone/Fax

Practice location:
  • Phone: 310-982-3141
  • Fax:
Mailing address:
  • Phone: 310-982-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number688400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: