Healthcare Provider Details

I. General information

NPI: 1104441401
Provider Name (Legal Business Name): AMECHI LILIAN OBODOAGHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 MARINE AVE
GARDENA CA
90247-3110
US

IV. Provider business mailing address

1720 MARINE AVE
GARDENA CA
90247-3110
US

V. Phone/Fax

Practice location:
  • Phone: 424-263-0728
  • Fax:
Mailing address:
  • Phone: 424-263-0728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95128977
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95128977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: