Healthcare Provider Details

I. General information

NPI: 1629121389
Provider Name (Legal Business Name): JOSEPHINE CHINYERE OBIALISI LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15317 FREEMAN AVE
LAWNDALE CA
90260
US

IV. Provider business mailing address

8425 BELFORD AVE
WESTCHESTER CA
90045-4313
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-4428
  • Fax:
Mailing address:
  • Phone: 310-216-7495
  • Fax: 310-216-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN152188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: