Healthcare Provider Details

I. General information

NPI: 1356909659
Provider Name (Legal Business Name): GERTRUDE OKORO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42007 THOROUGHBRED LN
MURRIETA CA
92562-6105
US

IV. Provider business mailing address

42007 THOROUGHBRED LN
MURRIETA CA
92562-6105
US

V. Phone/Fax

Practice location:
  • Phone: 951-397-3369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number331880541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: