Kenneth Ezenwa, RN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95080178 Issued in CA

Practice address

17467 Honey Maple St
Canyon Country, CA 91387-6870

Phone

(661) 212-5273

NPI assigned

Apr 8, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Inland Psychiatric Medical Group IncGroup PAC ID 9436062312, 119 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Inland Psychiatric Medical Group, Inc.

  • Psychiatry Physician
  • Redlands, CA
  • NPI 1649217761

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Nkwoji'S Care Services,a Nursing Corp

  • Primary Care Clinic/Center
  • Canyon Country, CA
  • NPI 1073216362
  NPD (past) Authorized official
• Inland Psychiatric Medical Group, Inc.

  • Psychiatry Physician
  • Redlands, CA
  • NPI 1336977990

  Single Specialty

  NPD
• Temecula Valley Hospital Inc

  • General Acute Care Hospital
  • Temecula, CA
  • NPI 1679816201
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1003379959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17467 HONEY MAPLE ST",
            "city": "CANYON COUNTRY",
            "state": "CA",
            "postal_code": "913876870",
            "telephone_number": "661-212-5273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17467 HONEY MAPLE ST",
            "city": "CANYON COUNTRY",
            "state": "CA",
            "postal_code": "913876870",
            "telephone_number": "661-212-5273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZENWA",
        "first_name": "KENNETH",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-08",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95080178",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95080178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mai Engelberg, PA-C
• Ghazaleh Erfanzadeh, MD.
• Erica Lauren Siegal, a Licensed Clinical Social Worker Corportation
• Sarah S Erolin
• Angel Joy Malanyaon Estrada, RDHAP
• Christopher Mark Faldmo, D.C.
• Family Model Behavior Therapy
• Family Model Behavior Therapy, LLC
• Kelsey Paige Feldman, MA, LMFT
• Rochelle C Feldman, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Canyon Country, CA
• Providers in Canyon Country, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.