Provider Demographics
NPI:1942957113
Name:AGULANNA, CHIKA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHIKA
Middle Name:
Last Name:AGULANNA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 N ENCINA AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-2945
Mailing Address - Country:US
Mailing Address - Phone:951-441-9846
Mailing Address - Fax:
Practice Address - Street 1:901 DOVER DR STE 214
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5500
Practice Address - Country:US
Practice Address - Phone:949-612-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019317163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult