Healthcare Provider Details

I. General information

NPI: 1497139349
Provider Name (Legal Business Name): CHINWEIKE OGBODO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17625 CENTRAL AVE
CARSON CA
90746-1661
US

IV. Provider business mailing address

17625 CENTRAL AVE
CARSON CA
90746-1661
US

V. Phone/Fax

Practice location:
  • Phone: 310-228-8682
  • Fax:
Mailing address:
  • Phone: 310-228-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: