Healthcare Provider Details

I. General information

NPI: 1871213843
Provider Name (Legal Business Name): PRAISE OWOYEMI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VETERAN AVE
LOS ANGELES CA
90024-2704
US

IV. Provider business mailing address

1000 VETERAN AVE RM 25-57
LOS ANGELES CA
90024-2704
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6110
  • Fax:
Mailing address:
  • Phone: 310-825-6110
  • Fax:

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: