Healthcare Provider Details

I. General information

NPI: 1518641075
Provider Name (Legal Business Name): OJENI MARDIROUSI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 WILSHIRE BLVD STE 410-L61
LOS ANGELES CA
90017-3209
US

IV. Provider business mailing address

626 WILSHIRE BLVD STE 410-L61
LOS ANGELES CA
90017-3209
US

V. Phone/Fax

Practice location:
  • Phone: 213-527-6712
  • Fax: 213-527-6713
Mailing address:
  • Phone: 213-527-6712
  • Fax: 213-527-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95025020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: