Healthcare Provider Details

I. General information

NPI: 1639735665
Provider Name (Legal Business Name): ERNEST OKWUONU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date: 01/13/2020
Reactivation Date: 04/03/2020

III. Provider practice location address

6500 WILSHIRE BLVD FL 19
LOS ANGELES CA
90048-4920
US

IV. Provider business mailing address

401 QUARRY RD
PALO ALTO CA
94304-1419
US

V. Phone/Fax

Practice location:
  • Phone: 805-764-9651
  • Fax:
Mailing address:
  • Phone: 805-764-9651
  • Fax: 747-330-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61551380
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA185688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: