Healthcare Provider Details

I. General information

NPI: 1801706825
Provider Name (Legal Business Name): NDIDI E OKUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 E 120TH ST
LOS ANGELES CA
90059-3026
US

IV. Provider business mailing address

5229 E EBELL ST
LONG BEACH CA
90808-1837
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-8000
  • Fax:
Mailing address:
  • Phone: 423-338-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number666717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: