Healthcare Provider Details

I. General information

NPI: 1699285064
Provider Name (Legal Business Name): IFUNANYA OLIVE IFEACHO FNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 CLAIREMONT MESA BLVD STE 200B
SAN DIEGO CA
92111-1320
US

IV. Provider business mailing address

PO BOX 602060
SAN DIEGO CA
92160-2060
US

V. Phone/Fax

Practice location:
  • Phone: 877-840-6956
  • Fax: 619-383-6701
Mailing address:
  • Phone: 877-840-6956
  • Fax: 619-383-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007648
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95007648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: