Healthcare Provider Details

I. General information

NPI: 1922666445
Provider Name (Legal Business Name): BENEDICTA IHUNNE OSUJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 E CYRENE DR
CARSON CA
90746-3102
US

IV. Provider business mailing address

1544 E CYRENE DR
CARSON CA
90746-3102
US

V. Phone/Fax

Practice location:
  • Phone: 310-259-0549
  • Fax:
Mailing address:
  • Phone: 310-259-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95011800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: