Healthcare Provider Details

I. General information

NPI: 1194440107
Provider Name (Legal Business Name): LYDIA NJIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH STREET STE 280
GARDENA CA
90248
US

IV. Provider business mailing address

910 S CASWELL AVE
COMPTON CA
90220-3918
US

V. Phone/Fax

Practice location:
  • Phone: 310-515-8113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95023400
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022030907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: