MEDICARE: ANIEMA EFFIONG UMOH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95027770	CA
2	101Y00000X	Counselor	RI-E0607271141	CA

General Provider Information

NPI Number	:	1780859181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANIEMA EFFIONG UMOH NP

Provider Business Mailing Address
First Line	:	1510 W 124TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5325
Country	:	US
Telephone Number	:	310-467-7434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 W 124TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5325
Country	:	US
Telephone Number	:	310-467-7434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	02/18/2026

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