Healthcare Provider Details

I. General information

NPI: 1154097061
Provider Name (Legal Business Name): FELIX OWUSU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 E CENTURY BLVD
LOS ANGELES CA
90002-3050
US

IV. Provider business mailing address

535 SAN PASCUAL AVE
LOS ANGELES CA
90042-3727
US

V. Phone/Fax

Practice location:
  • Phone: 323-374-6848
  • Fax:
Mailing address:
  • Phone: 626-437-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number707852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: