Provider Demographics
NPI:1285416545
Name:OKORONKWO, UKACHI (CMT)
Entity type:Individual
Prefix:
First Name:UKACHI
Middle Name:
Last Name:OKORONKWO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21701 FOOTHILL BLVD APT 107
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2151
Mailing Address - Country:US
Mailing Address - Phone:415-633-6107
Mailing Address - Fax:
Practice Address - Street 1:3947 OPAL ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2626
Practice Address - Country:US
Practice Address - Phone:415-633-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94345225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist