Provider Demographics
NPI:1417067257
Name:OSAKUE, CLEMENT
Entity Type:Individual
Prefix:
First Name:CLEMENT
Middle Name:
Last Name:OSAKUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 W 2ND ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1803
Mailing Address - Country:US
Mailing Address - Phone:909-388-0088
Mailing Address - Fax:
Practice Address - Street 1:357 W 2ND ST
Practice Address - Street 2:SUITE 8
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1803
Practice Address - Country:US
Practice Address - Phone:909-388-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36582106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist