Healthcare Provider Details

I. General information

NPI: 1063163608
Provider Name (Legal Business Name): JUDE E OKWOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 05/07/2024
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11261 SNOW BELL PL
FONTANA CA
92337-6864
US

IV. Provider business mailing address

11261 SNOW BELL PL
FONTANA CA
92337-6864
US

V. Phone/Fax

Practice location:
  • Phone: 310-528-5848
  • Fax:
Mailing address:
  • Phone: 310-528-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number95019723
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: