Provider Demographics
NPI:1487237889
Name:MADUAFOKWA, EUCHARIA OBIANUJU (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:EUCHARIA
Middle Name:OBIANUJU
Last Name:MADUAFOKWA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3477 MARICOPA ST APT 37
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4926
Mailing Address - Country:US
Mailing Address - Phone:310-971-3103
Mailing Address - Fax:
Practice Address - Street 1:7500 HELLMAN AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2216
Practice Address - Country:US
Practice Address - Phone:310-971-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017052363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95017052OtherNURSE PRACTITIONER
CA95062461OtherREGISTETRED NURSE