Healthcare Provider Details

I. General information

NPI: 1730493768
Provider Name (Legal Business Name): BELL HOSPITAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15603 HAWTHORNE BLVD SUITE 102
LAWNDALE CA
90260-2639
US

IV. Provider business mailing address

PO BOX 4444Y
LOS ANGELES CA
90044-0946
US

V. Phone/Fax

Practice location:
  • Phone: 310-674-1000
  • Fax:
Mailing address:
  • Phone: 310-674-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberFNP39403
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberFNP39403
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberFNP39403
License Number StateCA

VIII. Authorized Official

Name: DR. JERRY A. OKONKWOAGUOLU
Title or Position: MEDICAL DIRECTOR
Credential: MD, PHD
Phone: 310-674-1000