Provider Demographics
NPI:1770175291
Name:OMANYE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:OMANYE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:NAAMOMO
Authorized Official - Last Name:OTUBUAH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC, PMHNP
Authorized Official - Phone:909-985-5544
Mailing Address - Street 1:11161 MORNINGSTAR PL
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6561
Mailing Address - Country:US
Mailing Address - Phone:909-855-5445
Mailing Address - Fax:
Practice Address - Street 1:11161 MORNINGSTAR PL
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-6561
Practice Address - Country:US
Practice Address - Phone:909-855-5445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty