Healthcare Provider Details

I. General information

NPI: 1013334143
Provider Name (Legal Business Name): TOBECHI OKORONKWO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST A2 ROOM 18
OAKLAND CA
94602
US

IV. Provider business mailing address

1530 N POINSETTIA PL APT 217
LOS ANGELES CA
90046-7927
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-7618
  • Fax:
Mailing address:
  • Phone: 510-589-0618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA154569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: