Individual provider Active NPI

Tochi Pepertua Nwachukwu, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1285399949
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95019040 Issued in CA
Practice address
450 Bauchet St
Los Angeles, CA 90012-2907
Phone
(213) 893-5875
NPI assigned
Nov 7, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95019040 CA Primary

Addresses

Primary practice location

450 Bauchet St
Los Angeles, CA 90012-2907

Mailing address

17411 Nauset CT
Carson, CA 90746-1637
Phone (310) 402-9007

Other practice location 1

1225 W 190th St Ste 280
Gardena, CA 90248-4305
Phone (310) 515-8113

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230502003077 CA Practitioner - Nurse Practitioner 2264897958 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ehab Yacoub MD IncGroup PAC ID 5092099523, 179 clinicians
Neuro Fitness Medical CorporationGroup PAC ID 8325404585, 2 clinicians

Practice addresses (Care Compare)

1421 Guerneville Rd
Suite 200
Santa Rosa, CA 95403-7238
Phone (877) 515-8113

18726 S Western Ave
Suite 409
Gardena, CA 90248-3858
Phone (310) 819-8582

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ehab Yacoub MD Inc. CurrentSince Apr 17, 2023 Accepting new patients
Neuro Fitness Medical Corporation CurrentSince Jun 12, 2023 Accepting new patients

Locations

1225 W 190th St
Ste 280
Gardena, CA 90248
Phone (310) 515-8113

18726 S Western Ave
Ste 409
Gardena, CA 90248
Phone (310) 329-4835

17075 Devonshire St
Ste 204
Northridge, CA 91325
Phone (818) 368-8929

1421 Guerneville Rd
Ste 200
Santa Rosa, CA 95403
Phone (707) 512-4295

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1636243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1285399949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17411 NAUSET CT",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907461637",
            "telephone_number": "310-402-9007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 BAUCHET ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900122907",
            "telephone_number": "213-893-5875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 W 190th St Ste 280",
            "address_purpose": "LOCATION",
            "city": "Gardena",
            "state": "CA",
            "postal_code": "902484305",
            "country_code": "US",
            "telephone_number": "310-515-8113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NWACHUKWU",
        "first_name": "TOCHI",
        "middle_name": "PEPERTUA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-07",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95019040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.