Provider Demographics
NPI:1154767275
Name:OGUNKAH, GLADYS (RN)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:OGUNKAH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14719 HAWTHORNE BLVD
Mailing Address - Street 2:201
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1544
Mailing Address - Country:US
Mailing Address - Phone:310-219-2889
Mailing Address - Fax:310-219-2889
Practice Address - Street 1:14719 HAWTHORNE BLVD
Practice Address - Street 2:201
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1544
Practice Address - Country:US
Practice Address - Phone:310-219-2889
Practice Address - Fax:310-219-2889
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA672190163W00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse