Provider Demographics
NPI:1619661782
Name:OBINWANNE, JULIUS ANAYO
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:ANAYO
Last Name:OBINWANNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 W 6TH ST # 6
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1128
Mailing Address - Country:US
Mailing Address - Phone:909-731-2756
Mailing Address - Fax:909-494-7478
Practice Address - Street 1:363 W 6TH ST # 6
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1128
Practice Address - Country:US
Practice Address - Phone:909-731-2756
Practice Address - Fax:909-494-7478
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA773822163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health