Healthcare Provider Details

I. General information

NPI: 1881918522
Provider Name (Legal Business Name): INEADA OKAFOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: INEADA JACK MD

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 CORONADO CENTER DR STE 141
HENDERSON NV
89052-3977
US

IV. Provider business mailing address

10001 S EASTERN AVE SUITE 310
HENDERSON NV
89052-3907
US

V. Phone/Fax

Practice location:
  • Phone: 702-566-2400
  • Fax: 702-433-2477
Mailing address:
  • Phone:
  • Fax: 702-433-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14822
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: