Individual provider Active NPI

Julius Anayo Obinwanne

  • Home Health Registered Nurse
  • San Bernardino, CA
National Provider Identifier
1619661782
Registry record updated Jun 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health Registered NurseTaxonomy code 163WH0200X
License
773822 Issued in CA
Practice address
363 W 6TH St # 6
San Bernardino, CA 92401-1128
Phone
(909) 731-2756
Fax
(909) 494-7478
NPI assigned
Jun 2, 2023
Last updated
Jun 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered Nurse 163WH0200X 773822 CA Primary

Addresses

Primary practice location

363 W 6TH St # 6
San Bernardino, CA 92401-1128

Mailing address

363 W 6TH St # 6
San Bernardino, CA 92401-1128
Phone (909) 731-2756

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

LicenseStateTypeSpecialty
773822CAMDHome Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Comfort Home Healthcare Services LLC CurrentSince Jan 21, 2024 Accepting new patients

Locations

363 W 6th St
#6
San Bernardino, CA 92401
Phone (909) 443-2150

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1619661782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 W 6TH ST # 6",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011128",
            "telephone_number": "909-731-2756",
            "fax_number": "909-494-7478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 W 6TH ST # 6",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011128",
            "telephone_number": "909-731-2756",
            "fax_number": "909-494-7478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBINWANNE",
        "first_name": "JULIUS",
        "middle_name": "ANAYO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-02",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "CA",
            "license": "773822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.