Provider Demographics
NPI:1972957306
Name:GINIGEME, ADAOBI
Entity type:Individual
Prefix:
First Name:ADAOBI
Middle Name:
Last Name:GINIGEME
Suffix:
Gender:F
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 2371
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-0071
Mailing Address - Country:US
Mailing Address - Phone:855-565-8746
Mailing Address - Fax:844-565-8746
Practice Address - Street 1:4805 CLAYTON RD
Practice Address - Street 2:11
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2989
Practice Address - Country:US
Practice Address - Phone:855-565-8746
Practice Address - Fax:844-565-8746
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA730014163WG0000X, 163WI0500X
CA548003163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health