Healthcare Provider Details

I. General information

NPI: 1952134868
Provider Name (Legal Business Name): LILLIAN ADHIAMBO OCHIENG-OPIYO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19402 MI CASA CT
RIVERSIDE CA
92508-6827
US

IV. Provider business mailing address

19402 MI CASA CT
RIVERSIDE CA
92508-6827
US

V. Phone/Fax

Practice location:
  • Phone: 951-314-1091
  • Fax:
Mailing address:
  • Phone: 951-314-1091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number594759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: