Healthcare Provider Details

I. General information

NPI: 1417089871
Provider Name (Legal Business Name): OBIAGELI IFEOMA OBAH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13931 CHADRON AVE APT 20
HAWTHORNE CA
90250-3150
US

IV. Provider business mailing address

13931 CHADRON AVE APT 20
HAWTHORNE CA
90250-8202
US

V. Phone/Fax

Practice location:
  • Phone: 310-418-9398
  • Fax: 310-676-7741
Mailing address:
  • Phone: 310-418-9398
  • Fax: 310-676-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: