Healthcare Provider Details

I. General information

NPI: 1871025684
Provider Name (Legal Business Name): CHIAMAKA OKWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHIA OKWU

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 LINCOLN AVE 201
SAN RAFAEL CA
94901-2120
US

IV. Provider business mailing address

201 E 12TH ST 125
OAKLAND CA
94606-2272
US

V. Phone/Fax

Practice location:
  • Phone: 415-459-5999
  • Fax:
Mailing address:
  • Phone: 415-601-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: