Provider Demographics
NPI:1821665811
Name:OSCEOLA, FUAD PHILLIP ALAN
Entity Type:Individual
Prefix:
First Name:FUAD
Middle Name:PHILLIP ALAN
Last Name:OSCEOLA
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 1:860 OLD TOPANGA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-3818
Mailing Address - Country:US
Mailing Address - Phone:646-825-0969
Mailing Address - Fax:
Practice Address - Street 1:19730 VENTURA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2600
Practice Address - Country:US
Practice Address - Phone:646-825-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26930225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist