Provider Demographics
NPI:1609108950
Name:EBIRIEKWE, SYLVERNUS
Entity Type:Individual
Prefix:
First Name:SYLVERNUS
Middle Name:
Last Name:EBIRIEKWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20930 BONITA ST
Mailing Address - Street 2:SUITE Y
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3680
Mailing Address - Country:US
Mailing Address - Phone:310-532-3464
Mailing Address - Fax:310-532-6276
Practice Address - Street 1:20930 BONITA ST
Practice Address - Street 2:SUITE Y
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3680
Practice Address - Country:US
Practice Address - Phone:310-532-3464
Practice Address - Fax:310-532-6276
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)