Provider Demographics
NPI:1487109955
Name:OMORUYI, ESOHE ABEL (FNP)
Entity type:Individual
Prefix:
First Name:ESOHE
Middle Name:ABEL
Last Name:OMORUYI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FAIR OAKS AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5801
Mailing Address - Country:US
Mailing Address - Phone:626-346-2455
Mailing Address - Fax:
Practice Address - Street 1:3946 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3300
Practice Address - Country:US
Practice Address - Phone:916-564-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95004512OtherNURSE PRACTITIONER FURNISHING
CAF0516218OtherAMERICAN ACADEMY OF NURSE PRACTITIONER CERTIFICATION PROGRAM
CA827396OtherBOARD OF NURSING REGISTERED NURSING LICENSE
CA95004512OtherNURSE PRACTITIONER FURNISHING