Prince Okosun
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Hollywood, CA
NPI 1699099424 · NPPES record last updated Oct 3, 2022
Key facts
- NPI
- 1699099424
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 95017967 (CA)
- Practice address
- 6838 W Sunset Blvd
Hollywood, CA 90028-7008 - Phone
- (323) 461-3161
- Fax
- (323) 461-5683
- NPI assigned
- Mar 23, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 550304 | CA | MD | Psychiatric/Mental Health Registered Nurse |
| 95017967 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 550304 | CA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 95017967 | CA | Yes |
Addresses
Primary practice location
6838 W Sunset Blvd
Hollywood, CA 90028-7008
Mailing address
9808 Venice Blvd
Suite 700
Culver City, CA 90232-2732
Phone (310) 945-3350
Other practice location 1
9808 Venice Blvd
Suite 700
Culver City, CA 90232-2732
Phone (310) 945-3350
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All providers in Hollywood, CA · Psychiatric/Mental Health Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.