Healthcare Provider Details

I. General information

NPI: 1518734987
Provider Name (Legal Business Name): MIRIAN OBIOHA DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 WALNUT AVE
SACRAMENTO CA
95841-3707
US

IV. Provider business mailing address

4970 WALNUT AVE
SACRAMENTO CA
95841-3707
US

V. Phone/Fax

Practice location:
  • Phone: 916-543-1593
  • Fax: 877-466-7829
Mailing address:
  • Phone: 916-543-1593
  • Fax: 877-466-7829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: