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General NPI Number Information
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NPI Number | 1255385985
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Entity Type | Individual
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Provider Name | SANDE O OKELO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE 12-311 MDCC
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City | LOS ANGELES
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State | CA
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Zip | 90095-3075
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Country | US
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Telephone | 310-267-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 10833 LE CONTE AVE 32-263 CHS
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City | LOS ANGELES
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State | CA
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Zip | 90095-3075
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Country | US
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Telephone | 310-267-0606
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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 | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | D56975
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | A68246
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License Number State | CA
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