Provider Demographics
NPI:1417089871
Name:OBAH, OBIAGELI IFEOMA (NP)
Entity Type:Individual
Prefix:MRS
First Name:OBIAGELI
Middle Name:IFEOMA
Last Name:OBAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13931 CHADRON AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8202
Mailing Address - Country:US
Mailing Address - Phone:310-418-9398
Mailing Address - Fax:310-676-7741
Practice Address - Street 1:13931 CHADRON AVE APT 20
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3150
Practice Address - Country:US
Practice Address - Phone:310-418-9398
Practice Address - Fax:310-676-7741
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)