Healthcare Provider Details

I. General information

NPI: 1891965919
Provider Name (Legal Business Name): JUDE OKORO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 S WESTERN AVE
LOS ANGELES CA
90062-1105
US

IV. Provider business mailing address

20721 SHEARER AVE
CARSON CA
90745-1229
US

V. Phone/Fax

Practice location:
  • Phone: 323-290-4364
  • Fax:
Mailing address:
  • Phone: 310-465-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: