Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | NP95008930 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95008930 | CA |
NPI | 1235273749 |
---|---|
Provider Name | Mr. Dave Mallari Usman |
First Address | Cypress, CA 90630-6026 |
Second Address | Irvine, CA 92614-6482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 31/03/2020 |