Healthcare Provider Details

I. General information

NPI: 1245161983
Provider Name (Legal Business Name): NJIDEKA OBIOMA ANAZODO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22365 BARTON RD
GRAND TERRACE CA
92313-5015
US

IV. Provider business mailing address

1225 WALIN ST
COLTON CA
92324-4606
US

V. Phone/Fax

Practice location:
  • Phone: 909-370-2858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: