Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 20775 | CA |
NPI | 1003104167 |
---|---|
Provider Name | Obianuju Rivera |
First Address | Oxnard, CA 93035-1829 |
Second Address | Ventura, CA 93004-1378 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2011 |
Last Update Date | 04/08/2011 |