Healthcare Provider Details

I. General information

NPI: 1023931045
Provider Name (Legal Business Name): STELLA IFUNANYA MGBOBILA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W 103RD ST
LOS ANGELES CA
90003-4405
US

IV. Provider business mailing address

407 W 103RD ST
LOS ANGELES CA
90003-4405
US

V. Phone/Fax

Practice location:
  • Phone: 213-770-3107
  • Fax:
Mailing address:
  • Phone: 213-293-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN761488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: