Provider Demographics
NPI:1003529819
Name:OTUECHERE, IJEOMA
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:
Last Name:OTUECHERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19587 KRAMERIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6800
Mailing Address - Country:US
Mailing Address - Phone:909-587-7249
Mailing Address - Fax:
Practice Address - Street 1:19587 KRAMERIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-6800
Practice Address - Country:US
Practice Address - Phone:909-587-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95240290163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse