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General NPI Number Information
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NPI Number | 1386988558
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Entity Type | Organization
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Legal Business Name | THECLA MGBOJIRIKWE M.D INC
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Dates
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Enumeration Date | 11/12/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 3627 MANHATTAN BEACH BLVD
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City | LAWNDALE
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State | CA
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Zip | 90260-2410
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Country | US
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Telephone | 310-403-2857
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Fax |
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Provider Business Mailing Address
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Address Line | 3627 MANHATTAN BEACH BLVD
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City | LAWNDALE
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State | CA
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Zip | 90260-2410
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Country | US
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Telephone | 310-403-2857
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATION
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Name | DR. THECLA MGBOJIRIKWE
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Credential | M.D.
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Telephone | 310-402-2857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A83572
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License Number State | CA
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