Provider Demographics
NPI:1447865753
Name:OPARA, AGNES
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:OPARA
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 1:21030 GRESHAM STREET
Mailing Address - Street 2:UNIT #104
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-1706
Mailing Address - Country:US
Mailing Address - Phone:310-499-6367
Mailing Address - Fax:
Practice Address - Street 1:8491 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4218
Practice Address - Country:US
Practice Address - Phone:310-360-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95013334363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner