Provider Demographics
NPI:1528345667
Name:ORJIAKOR, THERESA OBY
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:OBY
Last Name:ORJIAKOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:OBY
Other - Last Name:ORJIAKOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:21504 SOUTH ROSITA DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-513-8060
Mailing Address - Fax:310-513-8060
Practice Address - Street 1:21504 S ROSITA DR
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-1655
Practice Address - Country:US
Practice Address - Phone:310-513-8060
Practice Address - Fax:310-513-8060
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19914363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner