Provider Demographics
NPI:1679305973
Name:CHINAKA, NZUBECHI ODINAKACHUKWU
Entity type:Individual
Prefix:MR
First Name:NZUBECHI
Middle Name:ODINAKACHUKWU
Last Name:CHINAKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 FALLVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-7411
Mailing Address - Country:US
Mailing Address - Phone:209-568-6203
Mailing Address - Fax:
Practice Address - Street 1:3770 HELEN PERRY RD
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-7420
Practice Address - Country:US
Practice Address - Phone:209-568-6203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily