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General NPI Number Information
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NPI Number | 1881400893
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Entity Type | Individual
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Provider Name | COLLINS CHUKWUEBUKA IKUEZE DNP
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Gender | Male
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 446 ALTA RD
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City | SAN DIEGO
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State | CA
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Zip | 92158-0001
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Country | US
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Telephone | 619-671-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 5165 CALLE SANDWAVES UNIT 10
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City | SAN DIEGO
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State | CA
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Zip | 92154-6308
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Country | US
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Telephone | 973-814-0547
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95032860
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License Number State | CA
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