Provider Demographics
NPI:1548975980
Name:ONWUASOANYA, OBIANUJU V
Entity type:Individual
Prefix:
First Name:OBIANUJU
Middle Name:V
Last Name:ONWUASOANYA
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 1:1872 E ABBOTTSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2902
Mailing Address - Country:US
Mailing Address - Phone:310-658-4625
Mailing Address - Fax:
Practice Address - Street 1:1218 S INGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3649
Practice Address - Country:US
Practice Address - Phone:310-910-0399
Practice Address - Fax:310-910-0384
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95026123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily