Healthcare Provider Details

I. General information

NPI: 1396525556
Provider Name (Legal Business Name): CHIKA MADUAKOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 CENTURY PARK E STE 400
LOS ANGELES CA
90067-2905
US

IV. Provider business mailing address

3491 WRENWOOD AVE
CLOVIS CA
93619-8980
US

V. Phone/Fax

Practice location:
  • Phone: 415-671-2165
  • Fax:
Mailing address:
  • Phone: 323-479-8967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95027495
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95027495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: