Healthcare Provider Details

I. General information

NPI: 1811211089
Provider Name (Legal Business Name): CLEMENT OGBUEHI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933B CENTINELA AVE
INGLEWOOD CA
90302-1501
US

IV. Provider business mailing address

6414 2ND AVE
LOS ANGELES CA
90043-4558
US

V. Phone/Fax

Practice location:
  • Phone: 310-677-5090
  • Fax:
Mailing address:
  • Phone: 323-244-7224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14827
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA14827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: