Healthcare Provider Details

I. General information

NPI: 1154767275
Provider Name (Legal Business Name): GLADYS OGUNKAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14719 HAWTHORNE BLVD 201
LAWNDALE CA
90260-1544
US

IV. Provider business mailing address

14719 HAWTHORNE BLVD 201
LAWNDALE CA
90260-1544
US

V. Phone/Fax

Practice location:
  • Phone: 310-219-2889
  • Fax: 310-219-2889
Mailing address:
  • Phone: 310-219-2889
  • Fax: 310-219-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number672190
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number672190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: