Provider Demographics
NPI:1447895073
Name:OSILESI, KEMI (AGNP)
Entity type:Individual
Prefix:MRS
First Name:KEMI
Middle Name:
Last Name:OSILESI
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 COCHRAN ST STE 492
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2780
Mailing Address - Country:US
Mailing Address - Phone:310-503-2515
Mailing Address - Fax:
Practice Address - Street 1:1943 SEASONS ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0580
Practice Address - Country:US
Practice Address - Phone:310-503-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAG10190130363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology