Provider Demographics
NPI:1770921652
Name:ILORI, SAMSON OLUWAFEMI (DNP, FNP-BC, NP-C)
Entity type:Individual
Prefix:MR
First Name:SAMSON
Middle Name:OLUWAFEMI
Last Name:ILORI
Suffix:
Gender:M
Credentials:DNP, FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 RONSON CT
Mailing Address - Street 2:#217
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1805
Mailing Address - Country:US
Mailing Address - Phone:858-279-1212
Mailing Address - Fax:858-279-1420
Practice Address - Street 1:4849 RONSON CT
Practice Address - Street 2:#217
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1805
Practice Address - Country:US
Practice Address - Phone:858-279-1212
Practice Address - Fax:858-279-1420
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily