MEDICARE: LAWRENCE OGBECHIE MD INC

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	208D00000X	General Practice Physician	A61959	CA
2	2084P0800X	Psychiatry Physician	A61959	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00A619590	OTHER	CA	LA MENTAL HEALTH

General Provider Information

NPI Number	:	1588611461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE OGBECHIE MD INC

Provider Business Mailing Address
First Line	:	1142 S DIAMOND BAR BLVD
Second Line	:	SUITE 406
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-2203
Country	:	US
Telephone Number	:	213-444-6271
Fax Number	:	909-992-3302

Provider Business Practice Location Address
First Line	:	2491 PACIFIC AVE
Second Line	:	SUITE 3
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2900
Country	:	US
Telephone Number	:	213-444-6271
Fax Number	:	909-992-3302

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. LAWRENCE O OGBECHIE
Credential	:	M.D
Telephone Number	:	213-444-6271

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	02/16/2015

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