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General NPI Number Information
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NPI Number | 1134239932
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Entity Type | Individual
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Provider Name | JERRY AZUBUIKE OKONKWOAGUOLU MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 15603 HAWTHORNE BLVD
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City | LAWNDALE
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State | CA
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Zip | 90260-2639
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Country | US
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Telephone | 310-644-4488
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Fax | 310-679-4035
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Provider Business Mailing Address
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Address Line | PO BOX 425
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City | LAWNDALE
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State | CA
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Zip | 90260-0425
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Country | US
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Telephone | 310-644-4488
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Fax | 310-679-4035
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A29427
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A29427
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | A29427
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License Number State | CA
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