Provider Demographics
NPI:1912698804
Name:OLOWOOKERE, MOROMOKE
Entity type:Individual
Prefix:
First Name:MOROMOKE
Middle Name:
Last Name:OLOWOOKERE
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 1:19327 BROADACRES AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2707
Mailing Address - Country:US
Mailing Address - Phone:310-706-7113
Mailing Address - Fax:
Practice Address - Street 1:19327 BROADACRES AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-2707
Practice Address - Country:US
Practice Address - Phone:310-706-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036450363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health