Healthcare Provider Details

I. General information

NPI: 1881056349
Provider Name (Legal Business Name): VIVIAN CHIMA OGUELI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 04/04/2020
Certification Date: 04/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE STE 450
ORANGE CA
92868-4224
US

IV. Provider business mailing address

1120 W LA VETA AVE STE 450
ORANGE CA
92868-4224
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-7047
  • Fax: 714-628-9140
Mailing address:
  • Phone: 714-509-7047
  • Fax: 714-628-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA152063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: