Healthcare Provider Details

I. General information

NPI: 1013128537
Provider Name (Legal Business Name): UNUAKPOVOTA NIXON OKAGBARE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 WEST STOCKER STREET SUITE 401
LOS ANGELES CA
90008-5123
US

IV. Provider business mailing address

3701 STOCKER ST STE 401
LOS ANGELES CA
90008-5123
US

V. Phone/Fax

Practice location:
  • Phone: 323-299-4000
  • Fax: 323-299-4004
Mailing address:
  • Phone: 323-299-4000
  • Fax: 323-299-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: