Provider Demographics
NPI:1326705179
Name:OSIBAMIRO, OLUWATOYIN ADENIKE (LVN)
Entity Type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:ADENIKE
Last Name:OSIBAMIRO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:OLUWATOYIN
Other - Middle Name:ADENIKE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:20210 DALFSEN AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2934
Mailing Address - Country:US
Mailing Address - Phone:310-894-2573
Mailing Address - Fax:
Practice Address - Street 1:6060 N PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-3711
Practice Address - Country:US
Practice Address - Phone:562-634-9534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN238324164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse