Individual provider Active NPI

Lydia Owuor

  • Psychiatric/Mental Health Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1700080744
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95023366 Issued in CA
Practice address
2500 Wilshire Blvd Ste 500
Los Angeles, CA 90057-4310
Phone
(213) 639-0242
NPI assigned
Jun 13, 2007
Last updated
Jan 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95023366 CA Primary
Rehabilitation Practitioner 225400000X NU

Addresses

Primary practice location

2500 Wilshire Blvd Ste 500
Los Angeles, CA 90057-4310

Mailing address

2500 Wilshire Blvd Ste 500
Los Angeles, CA 90057-4310
Phone (213) 639-0242

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
I20230808001001 CA Practitioner - Nurse Practitioner 2769844752 Reassigns benefits to 2 organizations

Care Compare profile

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

Practice addresses (Care Compare)

14541 Delano St
Van Nuys, CA 91411-2820
Phone (877) 515-8113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mellow Medical Inc a Professional Corporation CurrentSince Jun 26, 2023 Accepting new patients
Ehab Yacoub MD Inc. CurrentSince Jan 22, 2024 Accepting new patients
Portals Mental Health Past Accepting new patients
All Care Physical Therapy, P.C. Past Accepting new patients

Locations

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

12301 Wilshire Blvd
Ste 512
Los Angeles, CA 90025
Phone (888) 284-2779

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

6200 Stoneridge Mall Rd
Fl 3
Pleasanton, CA 94588
Phone (510) 902-9067

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

5201 Great America Pkwy
Ste 320
Santa Clara, CA 95054
Phone (323) 968-6182

14541 Delano St
Van Nuys, CA 91411
Phone (310) 515-8113

8235 Santa Monica Blvd
Ste 302
West Hollywood, CA 90046
Phone (310) 892-4284

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4

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": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1700080744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 WILSHIRE BLVD STE 500",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900574310",
            "telephone_number": "213-639-0242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 WILSHIRE BLVD STE 500",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900574310",
            "telephone_number": "213-639-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWUOR",
        "first_name": "LYDIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95023366",
            "primary": true
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.