Individual
DIVINE E OSEPHODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
501 PLUM ST APT 31, CAPITOLA, CA 95010-2233
(414) 378-5878
Mailing address
501 PLUM ST APT 31, CAPITOLA, CA 95010-2233
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95262916
CA
Other
Enumeration date
07/10/2024
Last updated
07/10/2024
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