Provider Demographics
NPI:1720466758
Name:OSUNDE, EFOSA CLARA
Entity Type:Individual
Prefix:MRS
First Name:EFOSA
Middle Name:CLARA
Last Name:OSUNDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-9035
Mailing Address - Country:US
Mailing Address - Phone:916-233-9914
Mailing Address - Fax:
Practice Address - Street 1:1113 PARADISE DR
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9035
Practice Address - Country:US
Practice Address - Phone:916-233-9914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA818333163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA163WP0808XMedicare UPIN