Healthcare Provider Details

I. General information

NPI: 1710404306
Provider Name (Legal Business Name): MAXINE C OKAFOR APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date: 05/07/2025
Reactivation Date: 06/20/2025

III. Provider practice location address

401 N BRAND BLVD STE 834
GLENDALE CA
91203-4451
US

IV. Provider business mailing address

1902 W UNION HILLS DR UNIT 41331
PHOENIX AZ
85080-4115
US

V. Phone/Fax

Practice location:
  • Phone: 323-568-1700
  • Fax: 323-568-1700
Mailing address:
  • Phone: 323-568-1700
  • Fax: 323-568-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134780
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95008984
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP134780
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number268777
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: