Healthcare Provider Details

I. General information

NPI: 1003194416
Provider Name (Legal Business Name): GLORIA NGOZI OKOH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLORIA NGOZI NWAGWU NP

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 W COMPTON BLVD
COMPTON CA
90220-3110
US

IV. Provider business mailing address

869 E GLADWICK ST
CARSON CA
90746-3818
US

V. Phone/Fax

Practice location:
  • Phone: 310-438-2151
  • Fax:
Mailing address:
  • Phone: 310-908-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19881
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: