Healthcare Provider Details

I. General information

NPI: 1336718667
Provider Name (Legal Business Name): IKECHUKWU JOSHUA NJOKU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 07/21/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 VIA CTR STE B
SAN DIEGO, VISTA CA
92081-6056
US

IV. Provider business mailing address

4883 RONSON CT STE I
SAN DIEGO CA
92111-1812
US

V. Phone/Fax

Practice location:
  • Phone: 760-294-1206
  • Fax: 760-294-1206
Mailing address:
  • Phone: 760-294-1206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: