Provider Demographics
NPI:1295218717
Name:OFOMAH, CHINYERE SANDRA
Entity type:Individual
Prefix:
First Name:CHINYERE
Middle Name:SANDRA
Last Name:OFOMAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0509
Mailing Address - Country:US
Mailing Address - Phone:209-312-9580
Mailing Address - Fax:209-312-9584
Practice Address - Street 1:1400 K ST STE I
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1018
Practice Address - Country:US
Practice Address - Phone:209-312-9580
Practice Address - Fax:209-312-9584
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical