Provider Demographics
NPI:1023854932
Name:OKPAH, CHRISTIAN CHUKWUKA
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:CHUKWUKA
Last Name:OKPAH
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 1:1850 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5629
Mailing Address - Country:US
Mailing Address - Phone:510-433-1150
Mailing Address - Fax:
Practice Address - Street 1:1850 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5629
Practice Address - Country:US
Practice Address - Phone:510-433-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN727897164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse