Provider Demographics
NPI:1457087892
Name:AWOSIKA, OLUMIDE OLADEHINDE
Entity Type:Individual
Prefix:
First Name:OLUMIDE
Middle Name:OLADEHINDE
Last Name:AWOSIKA
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 1:370 CRENSHAW BLVD STE E202E
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1732
Mailing Address - Country:US
Mailing Address - Phone:818-399-0670
Mailing Address - Fax:
Practice Address - Street 1:370 CRENSHAW BLVD STE E202E
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1732
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021798363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health