Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 279503 | NY |
N | 207RX0202X | Medical Oncology | A115182 | CA |
NPI | 1164726378 |
---|---|
Provider Name | Dr. Osagie Bello |
First Address | Los Angeles, CA 90084-7411 |
Second Address | Brawley, CA 92227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2011 |
Last Update Date | 28/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A115182 | STATE LICENSE (01) | CA |
FB2386503 | DEA (01) |