Healthcare Provider Details

I. General information

NPI: 1093300600
Provider Name (Legal Business Name): CHIUGO SANDRA OKONKWO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD STE 700
CULVER CITY CA
90232-6824
US

IV. Provider business mailing address

9808 VENICE BLVD STE 700
CULVER CITY CA
90232-6824
US

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax: 310-945-3356
Mailing address:
  • Phone: 310-945-3350
  • Fax: 310-945-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016653
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95016653
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95146810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: