1275966988 NPI number — EKERETTE J ESSIEN, PHD

Table of content: (NPI 1275966988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275966988 NPI number — EKERETTE J ESSIEN, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EKERETTE J ESSIEN, PHD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALIFORNIA STRESS CONTROL MGMT CTR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275966988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16795 CATALONIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92504-8705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-660-3050
Provider Business Mailing Address Fax Number:
888-235-1709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5206 BENITO ST
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91763-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-660-3050
Provider Business Practice Location Address Fax Number:
888-235-1709
Provider Enumeration Date:
08/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ESSIEN
Authorized Official First Name:
EKERETTE
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
951-660-3050

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY17740 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PSY177400 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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