Healthcare Provider Details

I. General information

NPI: 1275006686
Provider Name (Legal Business Name): SAFARI MARTIN SEKIYOBA DNP, FNP-BC, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 S GRAND AVE
LOS ANGELES CA
90007-3304
US

IV. Provider business mailing address

3840 WEST BLVD
LOS ANGELES CA
90008-1728
US

V. Phone/Fax

Practice location:
  • Phone: 213-699-7114
  • Fax:
Mailing address:
  • Phone: 323-594-9398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: