Provider Demographics
NPI:1700363918
Name:OFOEGBU, CHINYERE MARIA ASSUMPTA (NP)
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:MARIA ASSUMPTA
Last Name:OFOEGBU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13850 GARNET LN
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2585
Mailing Address - Country:US
Mailing Address - Phone:323-642-1045
Mailing Address - Fax:
Practice Address - Street 1:3865 JASMINE AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3105
Practice Address - Country:US
Practice Address - Phone:310-839-4381
Practice Address - Fax:310-815-2091
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008574363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner