Healthcare Provider Details

I. General information

NPI: 1922864644
Provider Name (Legal Business Name): KEL HEALTH AND WELLNESS NP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 CYPRESS AVE STE 3
LOS ANGELES CA
90065-1112
US

IV. Provider business mailing address

2210 NELSON AVE APT D
REDONDO BEACH CA
90278-2428
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 240-495-9715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELECHI JOELSON OKWARAJI
Title or Position: OWNER
Credential: NP
Phone: --