Provider Demographics
NPI:1689341109
Name:OTENIYA, VENESSA TERDOO (DNP)
Entity Type:Individual
Prefix:DR
First Name:VENESSA
Middle Name:TERDOO
Last Name:OTENIYA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4513
Mailing Address - Country:US
Mailing Address - Phone:951-925-2523
Mailing Address - Fax:
Practice Address - Street 1:1207 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4513
Practice Address - Country:US
Practice Address - Phone:951-925-2523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95017851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF95017851OtherCALIFORNIA BOARD OF NURSING