Provider Demographics
NPI:1104637412
Name:FORTUNA HEALTH GROUP-NURSING PRACTITIONER CORP
Entity type:Organization
Organization Name:FORTUNA HEALTH GROUP-NURSING PRACTITIONER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:N
Authorized Official - Last Name:OBIKE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:909-641-5451
Mailing Address - Street 1:9431 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5878
Mailing Address - Country:US
Mailing Address - Phone:925-785-7016
Mailing Address - Fax:
Practice Address - Street 1:9431 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5878
Practice Address - Country:US
Practice Address - Phone:925-785-7016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty