Provider Demographics
NPI:1760366272
Name:ACHOLONU, ROSE CHINASA
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:CHINASA
Last Name:ACHOLONU
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 1:1403 PREWETT RANCH DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8061
Mailing Address - Country:US
Mailing Address - Phone:510-435-8093
Mailing Address - Fax:925-706-2149
Practice Address - Street 1:1403 PREWETT RANCH DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8061
Practice Address - Country:US
Practice Address - Phone:510-435-8093
Practice Address - Fax:925-706-2149
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA079201340374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel