Healthcare Provider Details

I. General information

NPI: 1023710456
Provider Name (Legal Business Name): IFUNANYACHUKWU OLUBUNMI OKWUOSA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ STE 7501
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

757 WESTWOOD PLZ STE 7501
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-7375
  • Fax: 310-267-3595
Mailing address:
  • Phone: 310-825-7375
  • Fax: 310-267-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: