Healthcare Provider Details

I. General information

NPI: 1770148397
Provider Name (Legal Business Name): OLUSOLA ABOSEDE OPESEITAN-ODUMOSU NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E ALMOND AVE STE 103
MADERA CA
93637-5562
US

IV. Provider business mailing address

2059 E ECLIPSE AVE
FRESNO CA
93720-4615
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-4000
  • Fax:
Mailing address:
  • Phone: 559-273-0316
  • Fax: 559-433-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95011163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: