Healthcare Provider Details

I. General information

NPI: 1033099171
Provider Name (Legal Business Name): NNEOMA SUSAN OBINNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 10/24/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27300 IRIS AVE
MORENO VALLEY CA
92555-4802
US

IV. Provider business mailing address

35888 CARLTON RD
WILDOMAR CA
92595-7642
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95302735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: