Provider Demographics
NPI:1912565029
Name:OGBONNAYA, JOSEPH DINNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DINNE
Last Name:OGBONNAYA
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2894
Mailing Address - Country:US
Mailing Address - Phone:661-949-5000
Mailing Address - Fax:661-949-5238
Practice Address - Street 1:1600 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2894
Practice Address - Country:US
Practice Address - Phone:661-949-5000
Practice Address - Fax:661-949-5238
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA840092163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty