Provider Demographics
NPI:1811256829
Name:SARKODIE-MENSAH, KWABENA (LVN)
Entity type:Individual
Prefix:MR
First Name:KWABENA
Middle Name:
Last Name:SARKODIE-MENSAH
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:MR
Other - First Name:KOBBY
Other - Middle Name:
Other - Last Name:MENSAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3520 LONG BEACH BLVD
Mailing Address - Street 2:STE. 205
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3906
Mailing Address - Country:US
Mailing Address - Phone:562-426-5035
Mailing Address - Fax:
Practice Address - Street 1:3520 LONG BEACH BLVD
Practice Address - Street 2:STE. 205
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3906
Practice Address - Country:US
Practice Address - Phone:562-426-5035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN264129164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse