Healthcare Provider Details

I. General information

NPI: 1033371638
Provider Name (Legal Business Name): MR. NNAEMEKA MICHAEL OKONKWO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. MICHAEL N OKONKWO

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6109 S WESTERN AVE STE 201
LOS ANGELES CA
90047-1454
US

IV. Provider business mailing address

6109 S WESTERN AVE STE 201
LOS ANGELES CA
90047-1454
US

V. Phone/Fax

Practice location:
  • Phone: 323-752-0746
  • Fax: 323-752-0834
Mailing address:
  • Phone: 323-752-0746
  • Fax: 323-752-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number103060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: