Provider Demographics
NPI:1609564079
Name:OSHODI MEDICAL CORPORATION
Entity Type:Organization
Organization Name:OSHODI MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GANIYU
Authorized Official - Middle Name:O
Authorized Official - Last Name:OSHODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-696-0004
Mailing Address - Street 1:40770 CALIFORNIA OAKS RD STE A
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5794
Mailing Address - Country:US
Mailing Address - Phone:951-696-0004
Mailing Address - Fax:951-696-0007
Practice Address - Street 1:40770 CALIFORNIA OAKS RD STE A
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5794
Practice Address - Country:US
Practice Address - Phone:951-696-0004
Practice Address - Fax:951-696-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty