Provider Demographics
NPI:1003868217
Name:OGBECHIE, LAWRENCE O (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:O
Last Name:OGBECHIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1142 S DIAMOND BAR BLVD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2203
Mailing Address - Country:US
Mailing Address - Phone:562-989-1322
Mailing Address - Fax:562-989-1512
Practice Address - Street 1:2491 PACIFIC AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2900
Practice Address - Country:US
Practice Address - Phone:562-989-1322
Practice Address - Fax:562-989-1512
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-05-29
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Provider Licenses
StateLicense IDTaxonomies
CAA619592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A619590Medicaid
CAGR0082750Medicaid
CA954877267OtherTAX ID L OGBECHIE MD INC
CA330815723OtherTAX ID MENTAL HEALTH LA
CA954877267OtherTAX ID L OGBECHIE MD INC
G47739Medicare UPIN
CA00A619590Medicaid
CA330815723OtherTAX ID MENTAL HEALTH LA