Healthcare Provider Details

I. General information

NPI: 1417423138
Provider Name (Legal Business Name): ESE OGBETUO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22617 HAWTHORNE BLVD
TORRANCE CA
90505-2510
US

IV. Provider business mailing address

1000 SAN GABRIEL BLVD STE 200
ROSEMEAD CA
91770-4394
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-4700
  • Fax: 877-762-3439
Mailing address:
  • Phone: 323-724-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF95010120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: