Provider Demographics
NPI:1366249831
Name:OBINWANNE, COMFORT DABERECHI (NP)
Entity type:Individual
Prefix:
First Name:COMFORT
Middle Name:DABERECHI
Last Name:OBINWANNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COMFORT
Other - Middle Name:DABERECHI
Other - Last Name:EZEANOCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16729 YARROW LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-6638
Mailing Address - Country:US
Mailing Address - Phone:909-754-5890
Mailing Address - Fax:
Practice Address - Street 1:16729 YARROW LN
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-6638
Practice Address - Country:US
Practice Address - Phone:909-754-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF01251104363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care