Provider Demographics
NPI:1073882981
Name:OBIAGA, NKEM
Entity Type:Individual
Prefix:
First Name:NKEM
Middle Name:
Last Name:OBIAGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NKEM
Other - Middle Name:
Other - Last Name:OBIAGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10074 MUD HEN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6422
Mailing Address - Country:US
Mailing Address - Phone:916-340-4414
Mailing Address - Fax:
Practice Address - Street 1:10074 MUD HEN WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6422
Practice Address - Country:US
Practice Address - Phone:916-340-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA675598163WM0705X
CARPH63675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No183500000XPharmacy Service ProvidersPharmacist