Individual provider Active NPI

Amechi Lilian Obodoagha

  • Psychiatric/Mental Health Registered Nurse
  • Gardena, CA
National Provider Identifier
1104441401
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X
License
95128977 Issued in CA
Practice address
1720 Marine Ave
Gardena, CA 90247-3110
Phone
(424) 263-0728
NPI assigned
Jun 11, 2020
Last updated
Jul 28, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95128977 CA
Psychiatric/Mental Health Registered Nurse 163WP0808X 95128977 CA Primary

Addresses

Primary practice location

1720 Marine Ave
Gardena, CA 90247-3110

Mailing address

1720 Marine Ave
Gardena, CA 90247-3110
Phone (424) 263-0728

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201006002454 CA Practitioner - Nurse Practitioner 5395164677 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mobile Physicians Medical Allied Group Inc Multi-Specialty CurrentSince Oct 14, 2022 Accepting new patients
Global Mobile Medical Alliances, Inc. Multi-Specialty CurrentSince Oct 14, 2022 Accepting new patients
Global Integrated Medical Group, Inc. Multi-Specialty CurrentSince Sep 14, 2020 Accepting new patients
Global Medical GRP Inc Multi-Specialty CurrentSince Oct 14, 2022 Accepting new patients

Locations

1535 W Merced Ave
Ste 201
West Covina, CA 91790
Phone (626) 337-6246

1535 W Merced Ave
Ste 202
West Covina, CA 91790
Phone (626) 337-6246

818 W Cameron Ave
West Covina, CA 91790
Phone (626) 264-8847

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1104441401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 MARINE AVE",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473110",
            "telephone_number": "424-263-0728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 MARINE AVE",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473110",
            "telephone_number": "424-263-0728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBODOAGHA",
        "first_name": "AMECHI",
        "middle_name": "LILIAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-11",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95128977",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95128977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

Verify at the official NPI Registry.