Provider Demographics
NPI:1558019984
Name:OKONKWO, BEATRICE IHEGHARAUCHE
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:IHEGHARAUCHE
Last Name:OKONKWO
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 1:12555 CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3569
Mailing Address - Country:US
Mailing Address - Phone:909-902-1082
Mailing Address - Fax:909-628-3983
Practice Address - Street 1:12555 CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3569
Practice Address - Country:US
Practice Address - Phone:909-902-1082
Practice Address - Fax:909-628-3983
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020298363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health