Provider Demographics
NPI:1750566642
Name:EMMANUEL L OFOEGBU
Entity type:Organization
Organization Name:EMMANUEL L OFOEGBU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:OFOEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-529-7678
Mailing Address - Street 1:15718 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4352
Mailing Address - Country:US
Mailing Address - Phone:562-529-7678
Mailing Address - Fax:562-261-5857
Practice Address - Street 1:15718 PARAMOUNT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-4352
Practice Address - Country:US
Practice Address - Phone:562-529-7678
Practice Address - Fax:562-261-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47334332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6415230001Medicare NSC