Provider Demographics
NPI:1043566227
Name:OHANELE, CHIDI A
Entity Type:Individual
Prefix:
First Name:CHIDI
Middle Name:A
Last Name:OHANELE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7487 SANGIOVESE DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7733
Mailing Address - Country:US
Mailing Address - Phone:916-294-5566
Mailing Address - Fax:
Practice Address - Street 1:2425 BISSO LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4897
Practice Address - Country:US
Practice Address - Phone:925-521-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA786477163WC1500X, 163WG0000X, 163WP0807X, 163W00000X, 163WM0705X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult