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General NPI Number Information
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NPI Number | 1790597490
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Entity Type | Organization
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Legal Business Name | MEDIGENCE HEALTH NJ, PC
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 10960 WILSHIRE BLVD STE 406
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City | LOS ANGELES
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State | CA
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Zip | 90024-3704
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Country | US
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Telephone | 888-836-0510
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Fax |
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Provider Business Mailing Address
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Address Line | 10960 WILSHIRE BLVD STE 406
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City | LOS ANGELES
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State | CA
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Zip | 90024-3704
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNERS
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Name | OLUBUSOLA ABIYE BRIMMO
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Credential |
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Telephone | 888-836-0510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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