Provider Demographics
NPI:1043439813
Name:ANYAOHA, AMAKA LAURETTA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:AMAKA
Middle Name:LAURETTA
Last Name:ANYAOHA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:DR
Other - First Name:AMAKA
Other - Middle Name:L
Other - Last Name:ANYAOHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:23425 CRENSHAW BLVD #201
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-562-0166
Mailing Address - Fax:
Practice Address - Street 1:2101 ROSECRANS AVE # 3230
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4749
Practice Address - Country:US
Practice Address - Phone:323-628-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X, 101YA0400X
CARN 606596163WA0400X
CA23402363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)