Provider Demographics
NPI:1508948886
Name:MBADIKE-OBIORA, MAUREEN NNENE (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:NNENE
Last Name:MBADIKE-OBIORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-948-8143
Mailing Address - Fax:
Practice Address - Street 1:2415 HIGH SCHOOL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-685-8894
Practice Address - Fax:925-609-7558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A771700Medicaid
CA00A771700Medicaid