Healthcare Provider Details

I. General information

NPI: 1487532420
Provider Name (Legal Business Name): OGECHUKWU JULIET UDEOGU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD STE 505
CULVER CITY CA
90232-6818
US

IV. Provider business mailing address

14432 COTTAGE LN
HAWTHORNE CA
90250-0635
US

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax:
Mailing address:
  • Phone: 310-773-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number789696
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: