Healthcare Provider Details

I. General information

NPI: 1275967341
Provider Name (Legal Business Name): IMELDA OKOLI N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 HUGHES AVE STE 506
CULVER CITY CA
90232-6860
US

IV. Provider business mailing address

3831 HUGHES AVE STE 506
CULVER CITY CA
90232-6860
US

V. Phone/Fax

Practice location:
  • Phone: 310-280-9670
  • Fax: 310-280-9675
Mailing address:
  • Phone: 310-280-9670
  • Fax: 310-280-9675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95001474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: