Healthcare Provider Details

I. General information

NPI: 1396285698
Provider Name (Legal Business Name): AKPOBO AKPOROTU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 MAGNOLIA AVE
RIVERSIDE CA
92503-3528
US

IV. Provider business mailing address

495 E RINCON ST STE 208
CORONA CA
92879-1379
US

V. Phone/Fax

Practice location:
  • Phone: 855-745-8600
  • Fax: 951-758-8858
Mailing address:
  • Phone: 951-523-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA179694
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: