Healthcare Provider Details

I. General information

NPI: 1114336260
Provider Name (Legal Business Name): CHRIS OKWUOSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2014
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18310 US HIGHWAY 18
APPLE VALLEY CA
92307-2206
US

IV. Provider business mailing address

11755 MALAGA DR UNIT 1109
RANCHO CUCAMONGA CA
91730-8126
US

V. Phone/Fax

Practice location:
  • Phone: 760-998-2312
  • Fax: 760-242-3371
Mailing address:
  • Phone: 310-850-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7296
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberS9046
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA170738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: