Healthcare Provider Details

I. General information

NPI: 1487168456
Provider Name (Legal Business Name): ONYEBUCHI MICHAEL NWOSU FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W 58TH ST
LOS ANGELES CA
90037-3632
US

IV. Provider business mailing address

439 E 224TH ST
CARSON CA
90745-3945
US

V. Phone/Fax

Practice location:
  • Phone: 323-541-1600
  • Fax: 323-541-1661
Mailing address:
  • Phone: 310-533-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF03170624
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03170624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: