Provider Demographics
NPI:1922422856
Name:NWAKI, FIDELIS
Entity Type:Individual
Prefix:
First Name:FIDELIS
Middle Name:
Last Name:NWAKI
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 1:3741 STOCKER ST
Mailing Address - Street 2:
Mailing Address - City:VIEW PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5109
Mailing Address - Country:US
Mailing Address - Phone:213-507-0814
Mailing Address - Fax:
Practice Address - Street 1:3741 STOCKER ST
Practice Address - Street 2:
Practice Address - City:VIEW PARK
Practice Address - State:CA
Practice Address - Zip Code:90008-5109
Practice Address - Country:US
Practice Address - Phone:213-507-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626239163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health