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NPI Code Detail

MEDICARE: MR. EJERE OKORIE RN

MEDICARE: MR. EJERE OKORIE RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse95221316CA

General Provider Information

NPI Number : 1528816097
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EJERE OKORIE RN
Provider Business Mailing Address
First Line : 25774 MESA CT
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92404-3074
Country : US
Telephone Number : 909-278-0543
Fax Number :
Provider Business Practice Location Address
First Line : 815 S WILLOW AVE
Second Line :
City : RIALTO
State : CA
Zip : 92376-6934
Country : US
Telephone Number : 909-820-8150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2024
Last Update Date : 05/09/2024

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Directions to “ MR. EJERE OKORIE RN” Practice Location

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