Provider Demographics
NPI:1588611461
Name:LAWRENCE OGBECHIE MD INC
Entity Type:Organization
Organization Name:LAWRENCE OGBECHIE MD INC
Other - Org Name:PACIFIC BURNETT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:O
Authorized Official - Last Name:OGBECHIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-444-6271
Mailing Address - Street 1:1142 S DIAMOND BAR BLVD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2203
Mailing Address - Country:US
Mailing Address - Phone:213-444-6271
Mailing Address - Fax:909-992-3302
Practice Address - Street 1:2491 PACIFIC AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2900
Practice Address - Country:US
Practice Address - Phone:213-444-6271
Practice Address - Fax:909-992-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA619592084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082750Medicaid
CA00A619590OtherLA MENTAL HEALTH
CAG47739Medicare UPIN
CAGR0082750Medicaid