Healthcare Provider Details

I. General information

NPI: 1033002746
Provider Name (Legal Business Name): ENETARO NKWOCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 ADAMITE TER
HARBOR CITY CA
90710-3452
US

IV. Provider business mailing address

1277 ADAMITE TER
HARBOR CITY CA
90710-3452
US

V. Phone/Fax

Practice location:
  • Phone: 424-610-6004
  • Fax:
Mailing address:
  • Phone: 424-610-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: