Healthcare Provider Details

I. General information

NPI: 1164358883
Provider Name (Legal Business Name): CHERISH NKECHI SAMUEL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 LONG BEACH BLVD STE C3
LONG BEACH CA
90807-6009
US

IV. Provider business mailing address

3620 LONG BEACH BLVD STE C3
LONG BEACH CA
90807-6009
US

V. Phone/Fax

Practice location:
  • Phone: 562-352-4916
  • Fax: 562-261-1279
Mailing address:
  • Phone: 562-352-4916
  • Fax: 562-261-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: