Healthcare Provider Details

I. General information

NPI: 1043566227
Provider Name (Legal Business Name): CHIDI A OHANELE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 BISSO LN SUITE 100
CONCORD CA
94520-4897
US

IV. Provider business mailing address

7487 SANGIOVESE DR
EL DORADO HILLS CA
95762-7733
US

V. Phone/Fax

Practice location:
  • Phone: 925-521-5655
  • Fax:
Mailing address:
  • Phone: 916-294-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number786477
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number786477
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number786477
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number786477
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number786477
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number786477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: