Healthcare Provider Details

I. General information

NPI: 1124220488
Provider Name (Legal Business Name): ANTHONIA CHILEME OGELE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

IV. Provider business mailing address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

V. Phone/Fax

Practice location:
  • Phone: 310-627-5850
  • Fax: 310-627-5855
Mailing address:
  • Phone: 310-627-5850
  • Fax: 310-627-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA89913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: