1164858825 NPI number — DR. CALLISTUS EMEKA AMAJOYI CLINICAL PSYCHOLOGIS

Table of content: DR. CALLISTUS EMEKA AMAJOYI CLINICAL PSYCHOLOGIS (NPI 1164858825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164858825 NPI number — DR. CALLISTUS EMEKA AMAJOYI CLINICAL PSYCHOLOGIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMAJOYI
Provider First Name:
CALLISTUS
Provider Middle Name:
EMEKA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
CLINICAL PSYCHOLOGIS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1164858825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5050 JUNEAU CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91739-2653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-334-7172
Provider Business Mailing Address Fax Number:
909-803-0196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 S GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91740-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-691-1219
Provider Business Practice Location Address Fax Number:
626-691-0931
Provider Enumeration Date:
09/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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