Basic Information
| Provider Information | |||||||||
| NPI: | 1508440439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKAH | ||||||||
| FirstName: | OBINNA | ||||||||
| MiddleName: | BENJAMIN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4523 BARNSTONE RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | ROSHARON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775830377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9402286998 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 ROSECRANS AVE STE 3230 | ||||||||
| Address2: | |||||||||
| City: | EL SEGUNDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902454749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236288671 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2021 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 1016767 | TX | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 363LP0808X | 1016767 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.