Healthcare Provider Details

I. General information

NPI: 1952954794
Provider Name (Legal Business Name): LISA UGOMA OBASI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/25/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 810E
LOS ANGELES CA
90048-5958
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-967-4324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA181373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: