Healthcare Provider Details

I. General information

NPI: 1992309561
Provider Name (Legal Business Name): AMARACHI CHINWENDU IHEMEDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 W REDLANDS BLVD STE 103
REDLANDS CA
92373-8054
US

IV. Provider business mailing address

26610 BONITA HEIGHTS AVE
MORENO VALLEY CA
92555-4226
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-3026
  • Fax:
Mailing address:
  • Phone: 909-244-7778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95122487
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: