Provider Demographics
NPI:1205836731
Name:OFFODILE, REGINA STOKES (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:STOKES
Last Name:OFFODILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 N PRAIRIE AVE
Mailing Address - Street 2:SUITE #315
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4502
Mailing Address - Country:US
Mailing Address - Phone:310-672-2099
Mailing Address - Fax:310-672-2868
Practice Address - Street 1:323 N PRAIRIE AVE
Practice Address - Street 2:SUITE #315
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4502
Practice Address - Country:US
Practice Address - Phone:310-672-2099
Practice Address - Fax:310-672-2868
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60014208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A600140Medicaid
CAA60014Medicare ID - Type Unspecified
CA00A600140Medicaid