Provider Demographics
NPI:1114564549
Name:EKE, OLAMMA MARIA
Entity Type:Individual
Prefix:
First Name:OLAMMA
Middle Name:MARIA
Last Name:EKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 DELTA FAIR BLVD APT A40
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4056
Mailing Address - Country:US
Mailing Address - Phone:702-716-9015
Mailing Address - Fax:
Practice Address - Street 1:3100 DELTA FAIR BLVD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4001
Practice Address - Country:US
Practice Address - Phone:925-709-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst