Healthcare Provider Details

I. General information

NPI: 1306481221
Provider Name (Legal Business Name): OLUWASEYI OKUSANYA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date: 03/14/2025
Reactivation Date: 04/16/2025

III. Provider practice location address

2570 48TH ST
SACRAMENTO CA
95817-1541
US

IV. Provider business mailing address

16782 VON KARMAN AVE STE 11
IRVINE CA
92606-2417
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2145
  • Fax:
Mailing address:
  • Phone: 949-833-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: