MEDICARE: AMALA OSUJI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	95025592	CA

General Provider Information

NPI Number	:	1679339436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMALA OSUJI

Provider Business Mailing Address
First Line	:	4190 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5348
Country	:	US
Telephone Number	:	951-683-2106
Fax Number	:

Provider Business Practice Location Address
First Line	:	4190 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5348
Country	:	US
Telephone Number	:	951-632-2106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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