Healthcare Provider Details

I. General information

NPI: 1548488257
Provider Name (Legal Business Name): MR. BENNETH I OKORIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BENNETH I OKORIE B.A.

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W MANCHESTER BLVD SUITE A
INGLEWOOD CA
90301-1196
US

IV. Provider business mailing address

405 W MANCHESTER BLVD SUITE A
INGLEWOOD CA
90301-1196
US

V. Phone/Fax

Practice location:
  • Phone: 310-672-3820
  • Fax: 310-672-3822
Mailing address:
  • Phone: 310-672-3820
  • Fax: 310-672-3822

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: