Healthcare Provider Details

I. General information

NPI: 1275966988
Provider Name (Legal Business Name): EKERETTE J ESSIEN, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5206 BENITO ST STE 106
MONTCLAIR CA
91763-2852
US

IV. Provider business mailing address

16795 CATALONIA DR
RIVERSIDE CA
92504-8705
US

V. Phone/Fax

Practice location:
  • Phone: 951-660-3050
  • Fax: 888-235-1709
Mailing address:
  • Phone: 951-660-3050
  • Fax: 888-235-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17740
License Number StateCA

VIII. Authorized Official

Name: EKERETTE JOSEPH ESSIEN
Title or Position: OWNER
Credential: PHD
Phone: 951-660-3050