Healthcare Provider Details

I. General information

NPI: 1083471445
Provider Name (Legal Business Name): PRECISION HEALTH CONSULTING & CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 S WASHBURN AVE STE 22
CORONA CA
92882-3303
US

IV. Provider business mailing address

11762 DE PALMA RD STE 1C #507
CORONA CA
92883-8494
US

V. Phone/Fax

Practice location:
  • Phone: 951-339-8000
  • Fax: 951-339-8001
Mailing address:
  • Phone: 951-638-1315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUYEMISI ADERONKE OLUBI
Title or Position: CEO/CMO
Credential: MD MPH
Phone: 951-638-1315