Provider Demographics
NPI:1750356846
Name:OTUWA, SAMSON ORIAKU (MD)
Entity type:Individual
Prefix:
First Name:SAMSON
Middle Name:ORIAKU
Last Name:OTUWA
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 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2000
Mailing Address - Fax:702-383-3620
Practice Address - Street 1:1800 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-383-2000
Practice Address - Fax:702-383-3620
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYC2379207L00000X, 207LP3000X
NV11420207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002082602Medicaid
NV1750356846Medicaid
NC7616868OtherNORTH CAROLINA
NVXPY202599Q80OtherCALIFORNIA MEDICAID
NVXPY202599Q80OtherCALIFORNIA MEDICAID
F01343Medicare UPIN
NC7616868OtherNORTH CAROLINA