Provider Demographics
NPI:1497139349
Name:OGBODO, CHINWEIKE (NP)
Entity Type:Individual
Prefix:
First Name:CHINWEIKE
Middle Name:
Last Name:OGBODO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17625 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1661
Mailing Address - Country:US
Mailing Address - Phone:310-228-8682
Mailing Address - Fax:
Practice Address - Street 1:17625 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1661
Practice Address - Country:US
Practice Address - Phone:310-228-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily