Healthcare Provider Details

I. General information

NPI: 1073547220
Provider Name (Legal Business Name): ADE OSIBAMIRO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 E CARSON ST
CARSON CA
90810-1508
US

IV. Provider business mailing address

2637 E CARSON ST
CARSON CA
90810-1508
US

V. Phone/Fax

Practice location:
  • Phone: 310-847-1321
  • Fax:
Mailing address:
  • Phone: 310-847-1321
  • Fax: 310-847-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA64972
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS PETIT
Title or Position: DIRECTOR
Credential: MD
Phone: 310-847-1321