Healthcare Provider Details

I. General information

NPI: 1457804668
Provider Name (Legal Business Name): NNEKA NWANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14465 SALINE DR
EASTVALE CA
92880-3770
US

IV. Provider business mailing address

14465 SALINE DR
EASTVALE CA
92880-3770
US

V. Phone/Fax

Practice location:
  • Phone: 951-801-0549
  • Fax:
Mailing address:
  • Phone: 951-801-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95023790
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number678570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: