Provider Demographics
NPI:1255665105
Name:OBAZEE, FLORENCE OVENSEI
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:OVENSEI
Last Name:OBAZEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S WESTLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2906
Mailing Address - Country:US
Mailing Address - Phone:212-483-9201
Mailing Address - Fax:
Practice Address - Street 1:360 S WESTLAKE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2906
Practice Address - Country:US
Practice Address - Phone:212-483-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA196856000Medicaid
CACMM70956FMedicaid