=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003194416
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLORIA NGOZI OKOH NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2011
-----------------------------------------------------
Last Update Date | 12/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 349 W COMPTON BLVD
-----------------------------------------------------
City | COMPTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90220-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-438-2151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 869 E GLADWICK ST
-----------------------------------------------------
City | CARSON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90746-3818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-908-0601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 19881
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 19661
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------