Provider Demographics
NPI:1588969109
Name:OSAZUWA, AUGUSTINE OSEGBE (IDC)
Entity type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:OSEGBE
Last Name:OSAZUWA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4512
Mailing Address - Country:US
Mailing Address - Phone:951-291-4309
Mailing Address - Fax:
Practice Address - Street 1:1105 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4512
Practice Address - Country:US
Practice Address - Phone:951-291-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman