Provider Demographics
NPI:1740843309
Name:ONYENEKE, CHARLES EMEKA (NP-C)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EMEKA
Last Name:ONYENEKE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14427 LEMOLI AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-9056
Mailing Address - Country:US
Mailing Address - Phone:323-674-4755
Mailing Address - Fax:
Practice Address - Street 1:8711 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3216
Practice Address - Country:US
Practice Address - Phone:323-237-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily