Provider Demographics
NPI:1609416643
Name:OKEKE, EKWY ONYINYE
Entity Type:Individual
Prefix:
First Name:EKWY
Middle Name:ONYINYE
Last Name:OKEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EKWY
Other - Middle Name:ONYINYE
Other - Last Name:UDEGBUNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11942 PARAMOUNT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2306
Mailing Address - Country:US
Mailing Address - Phone:562-923-6060
Mailing Address - Fax:
Practice Address - Street 1:12472 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1005
Practice Address - Country:US
Practice Address - Phone:714-451-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily