Basic Information
| Provider Information | |||||||||
| NPI: | 1487008082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EZIMORA | ||||||||
| FirstName: | CANDY | ||||||||
| MiddleName: | OBIAGELI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 757 WESTWOOD PLZ STE 3304 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900958358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102678653 | ||||||||
| FaxNumber: | 3102673766 | ||||||||
| Practice Location | |||||||||
| Address1: | 757 WESTWOOD PLZ STE 3304 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900958358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102678653 | ||||||||
| FaxNumber: | 3102673766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2016 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 218062 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | A166500 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.