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Individual

THEO IKELE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
16260 VENTURA BLVD STE 630, ENCINO, CA 91436-2255
(747) 998-0387
Mailing address
16260 VENTURA BLVD STE 630, ENCINO, CA 91436-2255
(747) 998-0387

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
NP95008566
CA

Other

Enumeration date
06/26/2018
Last updated
06/05/2024
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