Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95003322 | CA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95003322 | CA |
NPI | 1003279118 |
---|---|
Provider Name | Calista E Ezeokoye |
First Address | Rosemead, CA 91770-4394 |
Second Address | Los Angeles, CA 90017-1931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2016 |
Last Update Date | 27/02/2020 |