NPIMap

Individual provider Active NPI

Emmanuel Ifemazi, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Gardena, CA
National Provider Identifier
1558052159
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95025107 Issued in CA
Practice address
1225 W 190TH St Ste 280
Gardena, CA 90248-4305
Phone
(877) 515-8113
NPI assigned
May 16, 2023
Last updated
Jan 31, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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 95025107 CA Primary

Addresses

Primary practice location

1225 W 190TH St Ste 280
Gardena, CA 90248-4305

Mailing address

1225 W 190TH St Ste 280
Gardena, CA 90248-4305
Phone (877) 515-8113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231106002130 CA Practitioner - Nurse Practitioner 0143677682 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Coast Behavioral Health IncGroup PAC ID 6204356660, 14 clinicians

Practice addresses (Care Compare)

4024 Rosemead Blvd
Pico Rivera, CA 90660-1774
Phone (747) 242-4186

536 Camino Mercado
Arroyo Grande, CA 93420-1814
Phone (805) 540-0279

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
J M Geiss DO Apc CurrentSince Jul 19, 2025 Accepting new patients
Senior Doc Integrated Med, PC CurrentSince Jul 19, 2025 Accepting new patients
Palm Desert Psychiatry Inc CurrentSince Feb 7, 2025 Accepting new patients
Central Coast Behavioral Health, Inc. Psychiatric/Mental Health CurrentSince Feb 7, 2025 Accepting new patients
Clarity Mental Wellness Inc Psychiatric/Mental Health CurrentSince Jul 30, 2025 Accepting new patients
Ruby Technology Services LLC Past Accepting new patients

Locations

536 Camino Mercado
Arroyo Grande, CA 93420
Phone (346) 502-3707

353 E Park Ave
El Cajon, CA 92020
Phone (323) 893-5844

7067 N Mariposa St
Ste 103
Fresno, CA 93720
Phone (559) 380-4304

520 Superior Ave
Ste 255
Newport Beach, CA 92663
Phone (949) 720-9266

74075 El Paseo
Ste A16
Palm Desert, CA 92260

5 Hutton Centre Dr
Ste 950
Santa Ana, CA 92707
Phone (855) 434-7663

28650 Newhall Ranch Rd
Santa Clarita, CA 91355
Phone (661) 347-0051

Organizations & group practices 7

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

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1558052159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 W 190TH ST STE 280",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484305",
            "telephone_number": "877-515-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 W 190TH ST STE 280",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484305",
            "telephone_number": "877-515-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IFEMAZI",
        "first_name": "EMMANUEL",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-16",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95025107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

Verify at the official NPI Registry.