MEDICARE: EKHATOR L OSAGIEDE P.A.-C

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	363A00000X	Physician Assistant	PA16227	CA

General Provider Information

NPI Number	:	1881783934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EKHATOR L OSAGIEDE P.A.-C

Provider Business Mailing Address
First Line	:	1145 MARKET ST
Second Line	:	FL 10
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1566
Country	:	US
Telephone Number	:	310-714-0189
Fax Number	:	310-714-0189

Provider Business Practice Location Address
First Line	:	508 VENICE WAY
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-2810
Country	:	US
Telephone Number	:	310-714-0189
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/09/2017

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