Healthcare Provider Details

I. General information

NPI: 1497682173
Provider Name (Legal Business Name): GENESIS RUTH OKUGBE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 THE CITY DR S STE 180
ORANGE CA
92868-4941
US

IV. Provider business mailing address

1910 S UNION ST UNIT 2004
ANAHEIM CA
92805-6792
US

V. Phone/Fax

Practice location:
  • Phone: 714-712-4150
  • Fax:
Mailing address:
  • Phone: 346-773-8412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: