Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | C51428 | CA |
Y | 208600000X | Surgeon | C51428 | CA |
NPI | 1003965153 |
---|---|
Provider Name | Dr. Samuel R Obiekwe |
First Address | San Diego, CA 92101-6096 |
Second Address | San Diego, CA 92101-6096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 12/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C514280 | (05) | CA |
E77117 | (02) | CA |