Healthcare Provider Details

I. General information

NPI: 1497612972
Provider Name (Legal Business Name): ELIZABETH OGAWA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HUNTINGTON DR
ARCADIA CA
91007-3402
US

IV. Provider business mailing address

2275 HUNTINGTON DR # 875
SAN MARINO CA
91108-2640
US

V. Phone/Fax

Practice location:
  • Phone: 626-898-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95349770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: