1285984450 NPI number — MR. OKECHUKU ROBERT NWANGANGA LCSW

Table of content: MR. OKECHUKU ROBERT NWANGANGA LCSW (NPI 1285984450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285984450 NPI number — MR. OKECHUKU ROBERT NWANGANGA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NWANGANGA
Provider First Name:
OKECHUKU
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NWANGANGA
Provider Other First Name:
OKECHUKU
Provider Other Middle Name:
ROBERT
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1285984450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 E LAS TUNAS DR
Provider Second Line Business Mailing Address:
#444
Provider Business Mailing Address City Name:
SAN GABRIEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91776-1614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-842-1791
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 E LAS TUNAS DR
Provider Second Line Business Practice Location Address:
#444
Provider Business Practice Location Address City Name:
SAN GABRIEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91776-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-842-1791
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2012

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: 104100000X , with the licence number:  27072 , 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)





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