Provider Demographics
NPI:1760073241
Name:OMOKO, ALEX OGHENEKEVWE
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:OGHENEKEVWE
Last Name:OMOKO
Suffix:
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 1:26 DRIFTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-1378
Mailing Address - Country:US
Mailing Address - Phone:213-245-3334
Mailing Address - Fax:
Practice Address - Street 1:60 GOLD CREST CT
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-6500
Practice Address - Country:US
Practice Address - Phone:925-267-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor