Healthcare Provider Details

I. General information

NPI: 1538500798
Provider Name (Legal Business Name): COMFORT FAMILY CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 N WILMINGTON BLVD
WILMINGTON CA
90744-4102
US

IV. Provider business mailing address

936 N WILMINGTON BLVD
WILMINGTON CA
90744-4102
US

V. Phone/Fax

Practice location:
  • Phone: 310-816-3111
  • Fax: 310-816-3116
Mailing address:
  • Phone: 310-816-3111
  • Fax: 310-816-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number14927
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THECLA N. MGBOJIRIKWE
Title or Position: MEDICAL DIRECTOR / OWNER
Credential: M.D.
Phone: 310-816-3111