Healthcare Provider Details

I. General information

NPI: 1265076715
Provider Name (Legal Business Name): PAULINE NNE UBANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 STUDEBAKER RD STE 110
CERRITOS CA
90703-2521
US

IV. Provider business mailing address

17215 STUDEBAKER RD STE 110
CERRITOS CA
90703-2521
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-2210
  • Fax: 562-860-1154
Mailing address:
  • Phone: 562-860-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94024356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: