Healthcare Provider Details

I. General information

NPI: 1003868217
Provider Name (Legal Business Name): LAWRENCE O OGBECHIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2491 PACIFIC AVE SUITE #3
LONG BEACH CA
90806-2900
US

IV. Provider business mailing address

1142 S DIAMOND BAR BLVD SUITE 406
DIAMOND BAR CA
91765-2203
US

V. Phone/Fax

Practice location:
  • Phone: 562-989-1322
  • Fax: 562-989-1512
Mailing address:
  • Phone: 562-989-1322
  • Fax: 562-989-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA61959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: