Healthcare Provider Details

I. General information

NPI: 1487089702
Provider Name (Legal Business Name): GLOBE NURSING NP PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 S. SUNSET AVE STE 105
WEST COVINA CA
91790-3410
US

IV. Provider business mailing address

640 S SUNSET AVE STE 102
WEST COVINA CA
91790-2808
US

V. Phone/Fax

Practice location:
  • Phone: 626-813-1222
  • Fax: 626-813-1221
Mailing address:
  • Phone: 626-338-9000
  • Fax: 626-338-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17752
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number17752
License Number StateCA

VIII. Authorized Official

Name: MR. OSAMAMWODE S. OGBEIWI
Title or Position: NP
Credential: FNP, PMHNP-BC
Phone: 626-813-1222