Individual provider Active NPI

Future Ogbebor

  • Psychiatric/Mental Health Nurse Practitioner
  • Gardena, CA
National Provider Identifier
1245961663
Registry record updated Dec 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2021208165 Issued in CA
Practice address
1225 W 190TH St Ste 280
Gardena, CA 90248-4305
Phone
(310) 515-8113
NPI assigned
Jun 17, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 31, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2021208165 CA Primary

Addresses

Primary practice location

1225 W 190TH St Ste 280
Gardena, CA 90248-4305

Mailing address

11401 Bloomfield Ave
Norwalk, CA 90650-2015
Phone (323) 571-7855

Other practice location 1

11401 Bloomfield Ave
Norwalk, CA 90650-2015
Phone (562) 863-7011

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
I20221213000531 CA Practitioner - Nurse Practitioner 3072982172 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ehab Yacoub MD IncGroup PAC ID 5092099523, 179 clinicians

Practice addresses (Care Compare)

1225 W 190TH St
Suite 280
Gardena, CA 90248-4305
Phone (877) 515-8113

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95022225CAMDRegistered Nurse
2021208165CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ehab Yacoub MD Inc. CurrentSince Nov 14, 2022 Accepting new patients
Divine Health Psychotherapy LLC Psychiatric/Mental Health CurrentSince Dec 24, 2025 Accepting new patients

Locations

1225 W 190th St
Ste 280
Gardena, CA 90248
Phone (310) 515-8113

39899 Balentine Dr
Ste 200
Newark, CA 94560
Phone (510) 270-8171

17075 Devonshire St
Ste 204
Northridge, CA 91325
Phone (818) 368-8929

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

3031 Tisch Way
San Jose, CA 95128
Phone (408) 260-0208

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1655424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767139200000",
    "number": "1245961663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11401 BLOOMFIELD AVE",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906502015",
            "telephone_number": "323-571-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 W 190TH ST STE 280",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484305",
            "telephone_number": "310-515-8113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11401 Bloomfield Ave",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CA",
            "postal_code": "906502015",
            "country_code": "US",
            "telephone_number": "562-863-7011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OGBEBOR",
        "first_name": "FUTURE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-17",
        "last_updated": "2025-12-31",
        "certification_date": "2025-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "2021208165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

Verify at the official NPI Registry.