Healthcare Provider Details

I. General information

NPI: 1942958905
Provider Name (Legal Business Name): BEATRICE OYIDIYA AKANIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11242 LUKE ST
RIVERSIDE CA
92505-2590
US

IV. Provider business mailing address

11242 LUKE ST
RIVERSIDE CA
92505-2590
US

V. Phone/Fax

Practice location:
  • Phone: 195-153-1545
  • Fax:
Mailing address:
  • Phone: 195-153-1545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: