MEDICARE: BRIDGET OGWONUWE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	43461	CA

General Provider Information

NPI Number	:	1003842493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGET OGWONUWE

Provider Business Mailing Address
First Line	:	6033 W CENTURY BLVD
Second Line	:	SUITE 400 (RM1142)
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-6410
Country	:	US
Telephone Number	:	310-649-7545
Fax Number	:	310-649-7546

Provider Business Practice Location Address
First Line	:	6033 W CENTURY BLVD
Second Line	:	SUITE 400 (RM1142)
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-6410
Country	:	US
Telephone Number	:	310-649-7545
Fax Number	:	310-649-7546

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BRIDGET ADA OGWONUWE
Credential	:
Telephone Number	:	310-649-7545

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	06/23/2008

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Directions to “BRIDGET OGWONUWE ” Practice Location

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