Healthcare Provider Details

I. General information

NPI: 1962862813
Provider Name (Legal Business Name): MR. UZEZI JOSHUA OBAROH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: UZEZI JOSHUA OBAROH NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21249 FIGUEROA ST UNIT 4
CARSON CA
90745-1900
US

IV. Provider business mailing address

21249 FIGUEROA ST UNIT 4
CARSON CA
90745-1900
US

V. Phone/Fax

Practice location:
  • Phone: 310-430-2277
  • Fax:
Mailing address:
  • Phone: 310-430-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: