Healthcare Provider Details

I. General information

NPI: 1861644460
Provider Name (Legal Business Name): SHARON KENECHUKWU OKONKWO-HOLMES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13652 CANTARA ST NORTH 3 BUILDING
PANORAMA CITY CA
91402-5423
US

IV. Provider business mailing address

13652 CANTARA ST NORTH 3 BUILDING
PANORAMA CITY CA
91402-5423
US

V. Phone/Fax

Practice location:
  • Phone: 888-778-5000
  • Fax:
Mailing address:
  • Phone: 888-778-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA102969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: