Healthcare Provider Details

I. General information

NPI: 1306140637
Provider Name (Legal Business Name): RIVY OLASUMBO OSENI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23860 HAWTHORNE BLVD STE 200
TORRANCE CA
90505-8201
US

IV. Provider business mailing address

3625 DEL AMO BLVD STE 120
TORRANCE CA
90503-1668
US

V. Phone/Fax

Practice location:
  • Phone: 310-791-3064
  • Fax:
Mailing address:
  • Phone: 310-512-8104
  • Fax: 310-324-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: