Provider Demographics
NPI:1033392261
Name:OCHUBA, GABE O (LVN WCC)
Entity Type:Individual
Prefix:
First Name:GABE
Middle Name:O
Last Name:OCHUBA
Suffix:
Gender:M
Credentials:LVN WCC
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:ONYEKWERE
Other - Last Name:OCHUBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12112 S VERMONT AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2974
Mailing Address - Country:US
Mailing Address - Phone:323-333-1713
Mailing Address - Fax:323-242-8951
Practice Address - Street 1:12112 S VERMONT AVE APT 10
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2974
Practice Address - Country:US
Practice Address - Phone:323-333-1713
Practice Address - Fax:323-242-8951
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN189227164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse