Provider Demographics
NPI:1407270697
Name:OHAERI, CHINEDU (DPT)
Entity Type:Individual
Prefix:DR
First Name:CHINEDU
Middle Name:
Last Name:OHAERI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 LUANE TRL
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-9351
Mailing Address - Country:US
Mailing Address - Phone:321-209-2012
Mailing Address - Fax:
Practice Address - Street 1:946 W. BEACH AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302
Practice Address - Country:US
Practice Address - Phone:321-209-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist