Provider Demographics
NPI:1013338557
Name:PURDY, KARLENE OKJAH
Entity Type:Individual
Prefix:
First Name:KARLENE
Middle Name:OKJAH
Last Name:PURDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 ALCAZAR ST
Mailing Address - Street 2:BLDG CHP 133
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0080
Mailing Address - Country:US
Mailing Address - Phone:323-442-3550
Mailing Address - Fax:
Practice Address - Street 1:1540 ALCAZAR ST
Practice Address - Street 2:BLDG CHP 133
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0080
Practice Address - Country:US
Practice Address - Phone:323-442-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program