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General NPI Number Information
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NPI Number | 1003279118
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Entity Type | Individual
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Provider Name | CALISTA E EZEOKOYE
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Gender | Female
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 2917 W VERNON AVE # B
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City | LOS ANGELES
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State | CA
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Zip | 90008-4714
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Country | US
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Telephone | 323-426-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 1338 E DENWALL DR STE 200
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City | CARSON
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State | CA
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Zip | 90746-3156
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Country | US
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Telephone | 323-426-5200
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Fax | 323-426-5252
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95003322
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95003322
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 95003322
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License Number State | CA
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