Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | A68246 | CA |
N | 2080P0214X | Pediatric Pulmonologist | D56975 | MD |
NPI | 1255385985 |
---|---|
Provider Name | Sande O Okelo |
First Address | Los Angeles, CA 90095-3075 |
Second Address | Los Angeles, CA 90095-3075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 16/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
952101100 | (05) | MD |
H97232 | (02) | MD |