Provider Demographics
NPI:1932663630
Name:OSUJI, AGATHA CHINYERE
Entity Type:Individual
Prefix:MRS
First Name:AGATHA
Middle Name:CHINYERE
Last Name:OSUJI
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 1:25222 ERICSON WAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5059
Mailing Address - Country:US
Mailing Address - Phone:512-963-3706
Mailing Address - Fax:
Practice Address - Street 1:3530 ATLANTIC AVE STE 101
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4569
Practice Address - Country:US
Practice Address - Phone:949-424-4724
Practice Address - Fax:949-502-8887
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily