Provider Demographics
NPI:1275967341
Name:OKOLI, IMELDA (NP)
Entity Type:Individual
Prefix:
First Name:IMELDA
Middle Name:
Last Name:OKOLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:STE 506
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6860
Mailing Address - Country:US
Mailing Address - Phone:310-280-9670
Mailing Address - Fax:310-280-9675
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:STE 506
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6860
Practice Address - Country:US
Practice Address - Phone:310-280-9670
Practice Address - Fax:310-280-9675
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001474363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health