Healthcare Provider Details

I. General information

NPI: 1447026943
Provider Name (Legal Business Name): TOCHUKWU TIKO-OBICHILI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD STE 505
CULVER CITY CA
90232-6818
US

IV. Provider business mailing address

9808 VENICE BLVD STE 505
CULVER CITY CA
90232-6818
US

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax:
Mailing address:
  • Phone: 310-945-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95346189
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number892973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: