Healthcare Provider Details

I. General information

NPI: 1144522517
Provider Name (Legal Business Name): CHARLES CHIDI OHAERI II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 INLAND EMPIRE BLVD 105
ONTARIO CA
91764-4802
US

IV. Provider business mailing address

2930 INLAND EMPIRE BLVD 105
ONTARIO CA
91764-4802
US

V. Phone/Fax

Practice location:
  • Phone: 909-980-6700
  • Fax: 909-980-6003
Mailing address:
  • Phone: 909-980-6700
  • Fax: 909-980-6003

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: