Healthcare Provider Details

I. General information

NPI: 1710544242
Provider Name (Legal Business Name): KELECHI UGONNA OLUKAIKPE OGOM PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E COLORADO BLVD STE 180&2ND
PASADENA CA
91101-6143
US

IV. Provider business mailing address

680 E COLORADO BLVD STE 180&2ND
PASADENA CA
91101-6143
US

V. Phone/Fax

Practice location:
  • Phone: 626-635-3112
  • Fax:
Mailing address:
  • Phone: 626-929-5930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95009577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: