Active NPI
Obiageli Philomena Ejim
- Dietary Manager
- Upland, CA
National Provider Identifier
1346918141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dietary Manager
- License
- 18941947
- Practice address
- 1012 W 7TH St Apt 104
Upland, CA 91786-6380 - Phone
- (909) 541-6106
- NPI assigned
- Sep 6, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dietary Manager | 132700000X | 18941947 | CA | Primary |
Addresses
Primary practice location
1012 W 7TH St Apt 104
Upland, CA 91786-6380
Mailing address
1012 W 7TH St Apt 104
Upland, CA 91786-6380
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18941947 | CA | MD | Dietary Manager |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630886400000",
"number": "1346918141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 W 7TH ST APT 104",
"city": "UPLAND",
"state": "CA",
"postal_code": "917866380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 W 7TH ST APT 104",
"city": "UPLAND",
"state": "CA",
"postal_code": "917866380",
"telephone_number": "909-541-6106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EJIM",
"first_name": "OBIAGELI",
"middle_name": "PHILOMENA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-06",
"last_updated": "2021-09-06",
"certification_date": "2021-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "132700000X",
"taxonomy_group": "",
"desc": "Dietary Manager",
"state": "CA",
"license": "18941947",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.