Healthcare Provider Details

I. General information

NPI: 1487373833
Provider Name (Legal Business Name): MISS OLUCHI OGECHI OKORO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HOWE AVE APT 636
SACRAMENTO CA
95825-8537
US

IV. Provider business mailing address

1100 HOWE AVE APT 636
SACRAMENTO CA
95825-8537
US

V. Phone/Fax

Practice location:
  • Phone: 916-585-1715
  • Fax:
Mailing address:
  • Phone: 916-585-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: