Healthcare Provider Details

I. General information

NPI: 1548449572
Provider Name (Legal Business Name): OKWII GLORIA AGBO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 FLORENCE AVENUE
LOS ANGELES CA
90001
US

IV. Provider business mailing address

P.O BOX 881916
LOS ANGELES CA
90009
US

V. Phone/Fax

Practice location:
  • Phone: 323-531-0915
  • Fax: 323-953-8446
Mailing address:
  • Phone: 323-531-0915
  • Fax: 323-953-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP14622
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNP14622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: