Healthcare Provider Details

I. General information

NPI: 1174402028
Provider Name (Legal Business Name): PATHWAY TO MENTAL WELLNESS A NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 POPPY DR
CARSON CA
90746-7457
US

IV. Provider business mailing address

1108 POPPY DR
CARSON CA
90746-7457
US

V. Phone/Fax

Practice location:
  • Phone: 469-638-3162
  • Fax:
Mailing address:
  • Phone: 469-638-3162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHINYERE IWUAGWU
Title or Position: OWNER
Credential:
Phone: 469-638-3162