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General NPI Number Information
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NPI Number | 1629703608
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Entity Type | Individual
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Provider Name | HENRIETHA UGOCHI IWOBI
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Gender | Female
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 13300 HAWTHORNE BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250
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Country | US
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Telephone | 424-365-3031
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Fax |
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Provider Business Mailing Address
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Address Line | 13532 1/2 CHADRON AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-7822
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Country | US
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Telephone | 424-200-9015
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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 | 95019958
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License Number State | CA
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