MEDICARE: CAROLINE NGWOKE

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	363LP2300X	Primary Care Nurse Practitioner	98006470	CA

General Provider Information

NPI Number	:	1487172656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE NGWOKE

Provider Business Mailing Address
First Line	:	11900 AVALON BLVD STE 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2867
Country	:	US
Telephone Number	:	323-756-1317
Fax Number	:	323-756-4015

Provider Business Practice Location Address
First Line	:	11900 AVALON BLVD STE 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2867
Country	:	US
Telephone Number	:	323-756-1317
Fax Number	:	323-756-4015

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

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	09/07/2017

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Directions to “ CAROLINE NGWOKE ” Practice Location

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