Provider Demographics
NPI:1790248300
Name:OGBOZOR, MAY
Entity Type:Individual
Prefix:
First Name:MAY
Middle Name:
Last Name:OGBOZOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARYROSE
Other - Middle Name:
Other - Last Name:OGBOZOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:13808 CERISE AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8723
Mailing Address - Country:US
Mailing Address - Phone:310-484-9048
Mailing Address - Fax:
Practice Address - Street 1:18040 SHERMAN WAY STE 300
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4631
Practice Address - Country:US
Practice Address - Phone:310-484-9048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010109363LF0000X
CANP95010109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95010109OtherNURSE PRACTITIONER NUMBER