Provider Demographics
NPI:1477371144
Name:METU, CHIMAMKPA
Entity type:Individual
Prefix:
First Name:CHIMAMKPA
Middle Name:
Last Name:METU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91603-0840
Mailing Address - Country:US
Mailing Address - Phone:858-609-9842
Mailing Address - Fax:
Practice Address - Street 1:1509 WILSON TER
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4007
Practice Address - Country:US
Practice Address - Phone:818-409-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 167G00000X, 323P00000X, 283Q00000X, 323P00000X, 374700000X, 3747P1801X
CA273R00000X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Yes283Q00000XHospitalsPsychiatric Hospital
No374700000XNursing Service Related ProvidersTechnician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant