Provider Demographics
NPI:1275899247
Name:BASSEY, OLAIDE AKIB (NP)
Entity Type:Individual
Prefix:
First Name:OLAIDE
Middle Name:AKIB
Last Name:BASSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MULIKAT
Other - Middle Name:OLAIDE
Other - Last Name:AKIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2830 W 235TH ST
Mailing Address - Street 2:#4
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4162
Mailing Address - Country:US
Mailing Address - Phone:310-701-5577
Mailing Address - Fax:
Practice Address - Street 1:12900 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-9329
Practice Address - Country:US
Practice Address - Phone:562-547-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily