Healthcare Provider Details

I. General information

NPI: 1063148419
Provider Name (Legal Business Name): CHINWE JULIAN ANEKWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11007 SKYGLOW DR
RANCHO CUCAMONGA CA
91730-9205
US

IV. Provider business mailing address

11007 SKYGLOW DR
RANCHO CUCAMONGA CA
91730-9205
US

V. Phone/Fax

Practice location:
  • Phone: 310-908-2120
  • Fax:
Mailing address:
  • Phone: 310-908-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1063148419
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95018973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: