Healthcare Provider Details

I. General information

NPI: 1144612805
Provider Name (Legal Business Name): UJU OSAGIE OWNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 H ST STE 120
SACRAMENTO CA
95814-1817
US

IV. Provider business mailing address

PO BOX 7982
PORTER RANCH CA
91327-7982
US

V. Phone/Fax

Practice location:
  • Phone: 818-212-9369
  • Fax: 818-212-9370
Mailing address:
  • Phone: 818-212-9369
  • Fax: 818-212-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002164
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95002164
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95002164
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95002164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: