Healthcare Provider Details

I. General information

NPI: 1649028978
Provider Name (Legal Business Name): NICCOLE ODETTE OGARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAPLE AVE
LOS ANGELES CA
90013-1511
US

IV. Provider business mailing address

PO BOX 470347
LOS ANGELES CA
90047-0347
US

V. Phone/Fax

Practice location:
  • Phone: 213-629-6248
  • Fax:
Mailing address:
  • Phone: 323-641-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: