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General NPI Number Information
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NPI Number | 1215214325
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Entity Type | Individual
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Provider Name | CHRISTIANA CHIMA ANISI NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 2112 S. GAREY AVE SUITE C
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City | POMONA
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State | CA
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Zip | 91766-5600
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Country | US
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Telephone | 909-464-0520
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Fax | 909-464-0523
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Provider Business Mailing Address
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Address Line | 14297 ANACAPA CT
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City | FONTANA
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State | CA
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Zip | 92336-3786
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Country | US
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Telephone | 909-829-0802
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Fax | 909-464-0523
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 20398
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License Number State | CA
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