Healthcare Provider Details

I. General information

NPI: 1598020299
Provider Name (Legal Business Name): IRENE IMUETIYAN OBANOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 OWENSMOUTH AVE FL 10
WOODLAND HILLS CA
91367-2262
US

IV. Provider business mailing address

6303 OWENSMOUTH AVE FL 10
WOODLAND HILLS CA
91367-2262
US

V. Phone/Fax

Practice location:
  • Phone: 626-254-1400
  • Fax: 626-447-4792
Mailing address:
  • Phone: 626-254-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95019425
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number793102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: