Healthcare Provider Details

I. General information

NPI: 1083414213
Provider Name (Legal Business Name): CHIEMELIE OGECHI ONYEKONWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNIVERSITY AVE
RIVERSIDE CA
92521-9800
US

IV. Provider business mailing address

900 UNIVERSITY AVE
RIVERSIDE CA
92521-9800
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-4334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: