Provider Demographics
NPI:1063148419
Name:ANEKWE, CHINWE JULIAN
Entity type:Individual
Prefix:
First Name:CHINWE
Middle Name:JULIAN
Last Name:ANEKWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11007 SKYGLOW DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-9205
Mailing Address - Country:US
Mailing Address - Phone:310-908-2120
Mailing Address - Fax:
Practice Address - Street 1:11007 SKYGLOW DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9205
Practice Address - Country:US
Practice Address - Phone:310-908-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063148419363LP0808X
CA95018973363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health