Healthcare Provider Details

I. General information

NPI: 1306571591
Provider Name (Legal Business Name): REMIGUS CHIMEZIE NWAOKORO PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 S COAST HWY # 140
LAGUNA BEACH CA
92651-3681
US

IV. Provider business mailing address

1968 S COAST HWY # 140
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 415-370-8412
  • Fax:
Mailing address:
  • Phone: 415-370-8412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: