Healthcare Provider Details

I. General information

NPI: 1194257741
Provider Name (Legal Business Name): DANIEL EBELE OKOBI JR. M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E ROLLINS ST # 6
ORLANDO FL
32804-5502
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6729
  • Fax: 407-628-2037
Mailing address:
  • Phone: 310-301-8707
  • Fax: 305-585-8137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA162136
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number82141
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME162637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: