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General NPI Number Information
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NPI Number | 1245961663
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Entity Type | Individual
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Provider Name | FUTURE OGBEBOR
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Gender | Female
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 1225 W 190TH ST STE 280
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City | GARDENA
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State | CA
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Zip | 90248-4305
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Country | US
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Telephone | 310-515-8113
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Fax |
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Provider Business Mailing Address
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Address Line | 11401 BLOOMFIELD AVE
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City | NORWALK
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State | CA
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Zip | 90650-2015
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Country | US
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Telephone | 562-863-7011
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2021208165
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License Number State | CA
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