Healthcare Provider Details

I. General information

NPI: 1871354118
Provider Name (Legal Business Name): IJEOMA MLEMCHUKWU PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14531 FREEMAN AVE APT 5
LAWNDALE CA
90260-1671
US

IV. Provider business mailing address

14531 FREEMAN AVE APT 5
LAWNDALE CA
90260-1671
US

V. Phone/Fax

Practice location:
  • Phone: 424-731-6622
  • Fax:
Mailing address:
  • Phone: 424-731-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95190967
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: