Healthcare Provider Details

I. General information

NPI: 1356038566
Provider Name (Legal Business Name): CHINASA PHOEBE ONYEMKPA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NICHOL HALL 2007 24951 NORTH CIRCLE DRIVE
LOMA LINDA CA
92350-0001
US

IV. Provider business mailing address

NICHOL HALL 2007 24951 NORTH CIRCLE DRIVE
LOMA LINDA CA
92350-0001
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-7622
  • Fax:
Mailing address:
  • Phone: 909-558-7622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberML61430895
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD61686600
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61686600
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD61686600
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61686600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: