Healthcare Provider Details

I. General information

NPI: 1770736670
Provider Name (Legal Business Name): CAROLINE IBEKWE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8939 S SEPULVEDA BLVD STE 460
LOS ANGELES CA
90045-3653
US

IV. Provider business mailing address

19422 NESTOR AVE
CARSON CA
90746-2610
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7417
  • Fax:
Mailing address:
  • Phone: 310-531-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: