Healthcare Provider Details

I. General information

NPI: 1982768412
Provider Name (Legal Business Name): ODIRA NGOZI OKEREKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W HERNDON AVE
CLOVIS CA
93612-0204
US

IV. Provider business mailing address

8679 N WHITNEY AVE
FRESNO CA
93720-3940
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-6200
  • Fax:
Mailing address:
  • Phone: 559-325-9846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA88906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: