Healthcare Provider Details

I. General information

NPI: 1508784604
Provider Name (Legal Business Name): SUSAN OKEBHAGBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 COUNTY FARM RD
RIVERSIDE CA
92503-3542
US

IV. Provider business mailing address

8961 TREE FARM LN
RIVERSIDE CA
92508-3090
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4700
  • Fax: 951-358-4810
Mailing address:
  • Phone: 714-679-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNPF95040164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: