Healthcare Provider Details

I. General information

NPI: 1104663418
Provider Name (Legal Business Name): CHIDINMA CHRISTABEL ONYEKWE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 W REDLANDS BLVD
REDLANDS CA
92373-8054
US

IV. Provider business mailing address

31883 WOODBANK WAY
WINCHESTER CA
92596-6620
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-3026
  • Fax:
Mailing address:
  • Phone: 321-368-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: