Healthcare Provider Details

I. General information

NPI: 1982352126
Provider Name (Legal Business Name): KATE N OKONGWU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 HOMAN ST
CHINO CA
91710-7305
US

IV. Provider business mailing address

6701 HOMAN ST
CHINO CA
91710-7305
US

V. Phone/Fax

Practice location:
  • Phone: 310-844-2020
  • Fax:
Mailing address:
  • Phone: 310-844-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95019788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: