Provider Demographics
NPI:1275286601
Name:UMUKORO, FELIX (MSN, RN, PMHNP)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:UMUKORO
Suffix:
Gender:M
Credentials:MSN, RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6640 MONTAIRE PL
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1067
Mailing Address - Country:US
Mailing Address - Phone:323-395-8596
Mailing Address - Fax:
Practice Address - Street 1:6640 MONTAIRE PL
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1067
Practice Address - Country:US
Practice Address - Phone:323-395-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019682363LP0808X
CA95168907163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health