Provider Demographics
NPI:1902567381
Name:OYIBU, CELIA TEYEE
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:TEYEE
Last Name:OYIBU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELIA
Other - Middle Name:TEYEE
Other - Last Name:WREH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:44161 11TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4239
Mailing Address - Country:US
Mailing Address - Phone:661-317-7354
Mailing Address - Fax:661-941-9178
Practice Address - Street 1:44161 11TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4239
Practice Address - Country:US
Practice Address - Phone:661-317-7354
Practice Address - Fax:661-941-9178
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6033190740376G00000X
CA197608907376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA465253796Medicaid