Healthcare Provider Details

I. General information

NPI: 1750291241
Provider Name (Legal Business Name): OSASERE OSAGIE EKHATOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29112 CARAVAN LN
HAYWARD CA
94545-4734
US

IV. Provider business mailing address

2050 FAIRMONT DR
SAN LEANDRO CA
94578
US

V. Phone/Fax

Practice location:
  • Phone: 510-895-5502
  • Fax: 510-895-7406
Mailing address:
  • Phone: 510-895-5502
  • Fax: 510-895-7406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: