Provider Demographics
NPI:1922488642
Name:ORIJA, JOHN OLADIMEJI
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:OLADIMEJI
Last Name:ORIJA
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 1:255 W 5TH ST
Mailing Address - Street 2:#906
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3388
Mailing Address - Country:US
Mailing Address - Phone:310-978-7882
Mailing Address - Fax:213-896-7239
Practice Address - Street 1:255 W 5TH ST
Practice Address - Street 2:#906
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3388
Practice Address - Country:US
Practice Address - Phone:310-978-7882
Practice Address - Fax:213-896-7239
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46-2397345171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor