Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | NP95009287 | CA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 95009287 | CA |
NPI | 1265902985 |
---|---|
Provider Name | Momoyo Ozawa |
First Address | Los Angeles, CA 90033-2414 |
Second Address | Los Angeles, CA 90033-2414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2018 |
Last Update Date | 23/11/2021 |