Provider Demographics
NPI:1568123016
Name:OKENWA, EMEKA (OPERATOR)
Entity Type:Individual
Prefix:
First Name:EMEKA
Middle Name:
Last Name:OKENWA
Suffix:
Gender:M
Credentials:OPERATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 BELVEDERE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-5904
Mailing Address - Country:US
Mailing Address - Phone:916-662-4786
Mailing Address - Fax:
Practice Address - Street 1:8440 BELVEDERE AVE STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-5904
Practice Address - Country:US
Practice Address - Phone:916-662-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)