Provider Demographics
NPI:1477680395
Name:EZEKA, EBERE SYLVESTER (LPT)
Entity Type:Individual
Prefix:
First Name:EBERE
Middle Name:SYLVESTER
Last Name:EZEKA
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6381 BLACKBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3424
Mailing Address - Country:US
Mailing Address - Phone:408-848-9802
Mailing Address - Fax:
Practice Address - Street 1:6381 BLACKBERRY CT
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3424
Practice Address - Country:US
Practice Address - Phone:408-848-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT31505167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician