MEDICARE: MR. OKECHUKU ROBERT NWANGANGA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	27072	CA

General Provider Information

NPI Number	:	1285984450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OKECHUKU ROBERT NWANGANGA LCSW

Provider Business Mailing Address
First Line	:	1005 E LAS TUNAS DR
Second Line	:	#444
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1614
Country	:	US
Telephone Number	:	323-842-1791
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 E LAS TUNAS DR
Second Line	:	#444
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1614
Country	:	US
Telephone Number	:	323-842-1791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	04/21/2013

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