Provider Demographics
NPI:1912732405
Name:OJEDA, EFRAIN HEREDIA
Entity type:Individual
Prefix:
First Name:EFRAIN
Middle Name:HEREDIA
Last Name:OJEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-1464
Mailing Address - Country:US
Mailing Address - Phone:951-258-0336
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1464
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-1464
Practice Address - Country:US
Practice Address - Phone:951-258-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171W00000X, 171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No171W00000XOther Service ProvidersContractor