Provider Demographics
NPI:1386368512
Name:ONYEKACHI, RAPHAEL EBUBECHUKWU
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:EBUBECHUKWU
Last Name:ONYEKACHI
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 1:700 EUBANK BLVD SE APT 518
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1300
Mailing Address - Country:US
Mailing Address - Phone:470-461-7149
Mailing Address - Fax:
Practice Address - Street 1:4113 EUBANK BLVD NE STE 200E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3482
Practice Address - Country:US
Practice Address - Phone:505-910-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide