Provider Demographics
NPI:1679457634
Name:ANOKWURU, FERDINAND OTUODI JR
Entity type:Individual
Prefix:
First Name:FERDINAND
Middle Name:OTUODI
Last Name:ANOKWURU
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 SAGE LN
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-1040
Mailing Address - Country:US
Mailing Address - Phone:443-325-3164
Mailing Address - Fax:
Practice Address - Street 1:1033 SAGE LN
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-1040
Practice Address - Country:US
Practice Address - Phone:443-325-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program