Healthcare Provider Details

I. General information

NPI: 1588611461
Provider Name (Legal Business Name): LAWRENCE OGBECHIE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/16/2015
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: 213-444-6271
  • Fax: 909-992-3302
Mailing address:
  • Phone: 213-444-6271
  • Fax: 909-992-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA61959
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA61959
License Number StateCA

VIII. Authorized Official

Name: DR. LAWRENCE O OGBECHIE
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 213-444-6271