Provider Demographics
NPI:1821354200
Name:MAURICE-DIYA, OMOLADE (MD)
Entity Type:Individual
Prefix:DR
First Name:OMOLADE
Middle Name:
Last Name:MAURICE-DIYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 GUNTREN RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8513
Mailing Address - Country:US
Mailing Address - Phone:352-870-0139
Mailing Address - Fax:
Practice Address - Street 1:10 GOVERNORS LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1991
Practice Address - Country:US
Practice Address - Phone:530-343-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128419208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine