Ekenedilichukwu Ezenwaka, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95030565 Issued in CA

Practice address

7707 Austin Rd
Stockton, CA 95215-8312

Phone

(209) 467-8655

NPI assigned

Jun 14, 2024

Last updated

Jun 14, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cep America - Psychiatry PC

  • Psychiatry Physician
  • Santa Maria, CA
  • NPI 1538757232
  Medicare reassignment NPD
• Cep America - Psychiatry PC

  • Psychiatry Physician
  • Indio, CA
  • NPI 1144195926
  NPD
• Cep America - Psychiatry PC

  • Psychiatry Physician
  • Modesto, CA
  • NPI 1396507547
  NPD

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

{
    "created_epoch": "1718323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1669215000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6713 SAO TIAGO WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957573435",
            "telephone_number": "323-973-6970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7707 AUSTIN RD",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952158312",
            "telephone_number": "209-467-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZENWAKA",
        "first_name": "EKENEDILICHUKWU",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-14",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95030565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evolve Physical Therapy PC
• Excel Non- Medical Transportation Service LLC (Excel Non-Medical Transportation)
• Excell E.N.T. Medical Group, Inc.
• Eyecheck Optometry Inc
• Crystal Eze, PMHNP-BC
• Ezra Medical Rehab & Recovery Center (Ceo)
• Ezra Medical Rehab & Recovery Center
• F Karl Gregorius M.D., Inc.
• Todd Fabian, MA, BCBA
• Karen M Fabreo-Hittle, P.T.

• Psychiatric/Mental Health Nurse Practitioner in Stockton, CA
• Providers in Stockton, 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 Jun 14, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.