Healthcare Provider Details

I. General information

NPI: 1205452315
Provider Name (Legal Business Name): AFFECTION HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 NORTH RIPON ROAD
RIPON CA
95366
US

IV. Provider business mailing address

1641 N RIPON RD APT 306
RIPON CA
95366-9817
US

V. Phone/Fax

Practice location:
  • Phone: 307-274-4066
  • Fax:
Mailing address:
  • Phone: 714-654-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMAECHI GEORGE OZOR
Title or Position: OWNER
Credential: FNP-BC
Phone: 714-654-4206