Healthcare Provider Details

I. General information

NPI: 1134683816
Provider Name (Legal Business Name): CHINYERE ANTHONIA OBAKHUME PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 01/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16232 MOORS LN
FONTANA CA
92336-5630
US

IV. Provider business mailing address

16232 MOORS LN
FONTANA CA
92336-5630
US

V. Phone/Fax

Practice location:
  • Phone: 310-910-3530
  • Fax: 909-822-3670
Mailing address:
  • Phone: 310-910-3530
  • Fax: 909-822-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95010609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: