Healthcare Provider Details

I. General information

NPI: 1184920050
Provider Name (Legal Business Name): VICTORIA OMUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD SUITE 700
CULVER CITY CA
90232-2732
US

IV. Provider business mailing address

PO BOX 4570
PALOS VERDES PENINSULA CA
90274-9607
US

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax: 310-840-7023
Mailing address:
  • Phone: 424-400-7748
  • Fax: 424-400-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number494863
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number494863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: