Healthcare Provider Details

I. General information

NPI: 1578267993
Provider Name (Legal Business Name): ASHLEY CHISOM OKUAGU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

1578 E SILVER REEF DR
CASA GRANDE AZ
85122-6424
US

V. Phone/Fax

Practice location:
  • Phone: 602-255-7821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number012065
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number343567
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: