Healthcare Provider Details

I. General information

NPI: 1629111018
Provider Name (Legal Business Name): DOUGLAS EGEONU OKPARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E LATHAM AVE STE A
HEMET CA
92543-4342
US

IV. Provider business mailing address

16465 SIERRA LAKES PKWY STE 115
FONTANA CA
92336-1242
US

V. Phone/Fax

Practice location:
  • Phone: 951-502-3500
  • Fax: 951-502-3400
Mailing address:
  • Phone: 909-823-8000
  • Fax: 909-823-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG53444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: