Healthcare Provider Details

I. General information

NPI: 1124520341
Provider Name (Legal Business Name): GEOFFREY PATRICK OKOTH ODHIAMBO DNP, PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2018
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N SEPULVEDA BLVD STE 270
MANHATTAN BEACH CA
90266-5975
US

IV. Provider business mailing address

1000 N SEPULVEDA BLVD STE 270
MANHATTAN BEACH CA
90266-5975
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006514
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95006514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: