Healthcare Provider Details

I. General information

NPI: 1669352639
Provider Name (Legal Business Name): JOSEF GEBRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

11734 BRADDOCK DR APT 370
CULVER CITY CA
90230-5162
US

V. Phone/Fax

Practice location:
  • Phone: 310-773-8722
  • Fax:
Mailing address:
  • Phone: 310-773-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: