Healthcare Provider Details

I. General information

NPI: 1003067141
Provider Name (Legal Business Name): ALICE CHINYERE ECHETA FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 ARLINGTON AVE STE B
RIVERSIDE CA
92504-2738
US

IV. Provider business mailing address

10976 BAMBOO CT
FONTANA CA
92337-6844
US

V. Phone/Fax

Practice location:
  • Phone: 951-341-8930
  • Fax:
Mailing address:
  • Phone: 909-201-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number560027
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number560027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: