Provider Demographics
NPI:1396594792
Name:OKORONKWO, ONYEMAECHI FRANCIS (NP)
Entity type:Individual
Prefix:MR
First Name:ONYEMAECHI
Middle Name:FRANCIS
Last Name:OKORONKWO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 SAND CREEK RD STE C-3141
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2707
Mailing Address - Country:US
Mailing Address - Phone:925-705-2870
Mailing Address - Fax:
Practice Address - Street 1:2420 SAND CREEK RD STE C-3141
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2707
Practice Address - Country:US
Practice Address - Phone:925-705-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030130363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty