=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477841708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. PAUL BWINIKA CHIKURU
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2011
-----------------------------------------------------
Last Update Date | 07/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5005 TEXAS ST SUITE 203
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-3721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-692-0727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5925 EL CAJON BLVD APT 316
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92115-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-368-8680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | D7730438
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------