Provider Demographics
NPI:1003104167
Name:RIVERA, OBIANUJU (FNP)
Entity Type:Individual
Prefix:
First Name:OBIANUJU
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:UJU
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-576-7900
Mailing Address - Fax:
Practice Address - Street 1:3801 UNIVERSITY AVE STE 270
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3272
Practice Address - Country:US
Practice Address - Phone:855-427-2778
Practice Address - Fax:951-530-3997
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20775363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily