Provider Demographics
NPI:1437551561
Name:OTUBUAH, PRISCILLA NAAMOMO (PHD, DNP, FNP, B-C;)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:NAAMOMO
Last Name:OTUBUAH
Suffix:
Gender:F
Credentials:PHD, DNP, FNP, B-C;
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24950 REDLANDS BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4028
Mailing Address - Country:US
Mailing Address - Phone:909-283-4033
Mailing Address - Fax:855-621-1987
Practice Address - Street 1:24950 REDLANDS BLVD STE F
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4028
Practice Address - Country:US
Practice Address - Phone:909-440-6849
Practice Address - Fax:909-440-6840
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily