Healthcare Provider Details

I. General information

NPI: 1700080744
Provider Name (Legal Business Name): LYDIA OWUOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WILSHIRE BLVD STE 500
LOS ANGELES CA
90057-4310
US

IV. Provider business mailing address

2500 WILSHIRE BLVD STE 500
LOS ANGELES CA
90057-4310
US

V. Phone/Fax

Practice location:
  • Phone: 213-639-0242
  • Fax:
Mailing address:
  • Phone: 213-639-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95023366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: