Healthcare Provider Details

I. General information

NPI: 1831944834
Provider Name (Legal Business Name): NILY OSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 WILSHIRE BLVD STE 790
SANTA MONICA CA
90403-4805
US

IV. Provider business mailing address

2811 WILSHIRE BLVD STE 790
SANTA MONICA CA
90403-4805
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-6005
  • Fax: 310-829-1389
Mailing address:
  • Phone: 310-453-6005
  • Fax: 310-829-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA195420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: