Provider Demographics
NPI:1699410746
Name:OBIOHA, NDUBUISI CHIMEZIE (NP)
Entity Type:Individual
Prefix:
First Name:NDUBUISI
Middle Name:CHIMEZIE
Last Name:OBIOHA
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 1:2917 W VERNON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-4714
Mailing Address - Country:US
Mailing Address - Phone:323-426-5200
Mailing Address - Fax:323-426-5252
Practice Address - Street 1:18836 PEPPERDINE DR
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3904
Practice Address - Country:US
Practice Address - Phone:323-788-4274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95020670363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health