1437551561 NPI number — DR. PRISCILLA NAAMOMO OTUBUAH PHD, DNP, FNP, B-C;

Table of content: DR. PRISCILLA NAAMOMO OTUBUAH PHD, DNP, FNP, B-C; (NPI 1437551561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437551561 NPI number — DR. PRISCILLA NAAMOMO OTUBUAH PHD, DNP, FNP, B-C;

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTUBUAH
Provider First Name:
PRISCILLA
Provider Middle Name:
NAAMOMO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, DNP, FNP, B-C;
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437551561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24950 REDLANDS BLVD STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOMA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92354-4028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-283-4033
Provider Business Mailing Address Fax Number:
855-621-1987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24950 REDLANDS BLVD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOMA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92354-4028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-440-6849
Provider Business Practice Location Address Fax Number:
909-440-6840
Provider Enumeration Date:
09/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  95000921 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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