Healthcare Provider Details

I. General information

NPI: 1609946656
Provider Name (Legal Business Name): OSAHON OSIFO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N INDIAN CANYON DR
PALM SPRINGS CA
92262-4872
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 949-757-0900
  • Fax: 530-243-0445
Mailing address:
  • Phone: 706-650-0705
  • Fax: 706-434-8806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA76458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: