Healthcare Provider Details

I. General information

NPI: 1073109773
Provider Name (Legal Business Name): PATIENCE AKHIMIEN REGISTERED NURSE PRACTITIONER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 RED OAK DR
EASTVALE CA
92880-8651
US

IV. Provider business mailing address

6515 RED OAK DR
EASTVALE CA
92880-8651
US

V. Phone/Fax

Practice location:
  • Phone: 310-956-0556
  • Fax:
Mailing address:
  • Phone: 310-956-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. PATIENCE RONKE AKHIMIEN
Title or Position: DR/NP
Credential: PMHNP
Phone: 310-956-0556