Healthcare Provider Details

I. General information

NPI: 1588492193
Provider Name (Legal Business Name): EUNICE OGUTU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 WILSHIRE BLVD STE 200
LOS ANGELES CA
90025-1023
US

IV. Provider business mailing address

12301 WILSHIRE BLVD STE 200
LOS ANGELES CA
90025-1023
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-2293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: