Healthcare Provider Details

I. General information

NPI: 1942544812
Provider Name (Legal Business Name): NATHAN OBIORAH OGBATUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11860 MAGNOLIA AVENUE, SUITE J,
RIVERSIDE CA
92503-4911
US

IV. Provider business mailing address

11860 MAGNOLIA AVENUE, SUITE J,
RIVERSIDE CA
92503-4911
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-2300
  • Fax: 951-352-2333
Mailing address:
  • Phone: 951-352-2300
  • Fax: 951-352-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: