Healthcare Provider Details

I. General information

NPI: 1508896275
Provider Name (Legal Business Name): VALENTINE U OTUECHERE MD., MPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 GARFIELD ST STE 6
RIVERSIDE CA
92503-3922
US

IV. Provider business mailing address

8990 GARFIELD ST STE 6
RIVERSIDE CA
92503-3922
US

V. Phone/Fax

Practice location:
  • Phone: 951-343-1616
  • Fax: 951-343-1666
Mailing address:
  • Phone: 951-343-1616
  • Fax: 951-343-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA93662
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA93662
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA93662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: