Healthcare Provider Details

I. General information

NPI: 1023675683
Provider Name (Legal Business Name): JESSICA CHICHEBEM OWAKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GRAYS HARBOR COMMUNITY HOSPITAL 915 ANDERSON DR.
ABERDEEN WA
98520
US

IV. Provider business mailing address

5850 S MANSFIELD AVE
LOS ANGELES CA
90043-3317
US

V. Phone/Fax

Practice location:
  • Phone: 360-532-8330
  • Fax:
Mailing address:
  • Phone: 323-674-4217
  • 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: