Healthcare Provider Details

I. General information

NPI: 1720618614
Provider Name (Legal Business Name): CHINYERE OLIVE NJOKU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 S MANSFIELD AVE
LOS ANGELES CA
90019-1631
US

IV. Provider business mailing address

1013 S MANSFIELD AVE
LOS ANGELES CA
90019-1631
US

V. Phone/Fax

Practice location:
  • Phone: 323-892-7581
  • Fax:
Mailing address:
  • Phone: 323-892-7581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95012703
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number674742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: