Provider Demographics
NPI:1043751886
Name:OLELEWE, OGBONNA IWUAMADI (NP-C)
Entity type:Individual
Prefix:
First Name:OGBONNA
Middle Name:IWUAMADI
Last Name:OLELEWE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90714-0507
Mailing Address - Country:US
Mailing Address - Phone:562-277-2586
Mailing Address - Fax:562-633-4662
Practice Address - Street 1:11712 S. HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-679-9293
Practice Address - Fax:310-679-4017
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006315363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily