Healthcare Provider Details

I. General information

NPI: 1619693942
Provider Name (Legal Business Name): OBIAJULUM OKAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date: 06/04/2025
Reactivation Date: 07/24/2025

III. Provider practice location address

9890 COUNTY FARM RD STE 2
RIVERSIDE CA
92503-3678
US

IV. Provider business mailing address

9890 COUNTY FARM RD STE 2
RIVERSIDE CA
92503-3678
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-2499
  • Fax: 951-358-7166
Mailing address:
  • Phone: 951-509-2499
  • Fax: 951-358-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: