Healthcare Provider Details

I. General information

NPI: 1043149248
Provider Name (Legal Business Name): FESTUS O NNADI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2059
US

IV. Provider business mailing address

14210 S VERMONT AVE APT 113
GARDENA CA
90247-2273
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-4000
  • Fax:
Mailing address:
  • Phone: 323-805-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: