Healthcare Provider Details

I. General information

NPI: 1790282960
Provider Name (Legal Business Name): VIVIENNE AGHOGHO AYOMANOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

12235 DUNE ST
NORWALK CA
90650-2079
US

V. Phone/Fax

Practice location:
  • Phone: 213-705-9332
  • Fax: 323-541-1401
Mailing address:
  • Phone: 310-561-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03180872
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number2022002084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: