Provider Demographics
NPI:1669672861
Name:CHUKWUMA, EKENE O
Entity Type:Individual
Prefix:MR
First Name:EKENE
Middle Name:O
Last Name:CHUKWUMA
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 1:3818 W 59TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2924
Mailing Address - Country:US
Mailing Address - Phone:310-489-4608
Mailing Address - Fax:323-299-9692
Practice Address - Street 1:3818 W 59TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2924
Practice Address - Country:US
Practice Address - Phone:310-489-4608
Practice Address - Fax:323-299-9692
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1669672861225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner