Provider Demographics
NPI:1447088406
Name:ODUOR, IRENE SERUYA AGUTU (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:SERUYA AGUTU
Last Name:ODUOR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7819 DANNER CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6866
Mailing Address - Country:US
Mailing Address - Phone:909-528-2321
Mailing Address - Fax:
Practice Address - Street 1:7819 DANNER CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6866
Practice Address - Country:US
Practice Address - Phone:909-528-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651191163WM0705X, 163WP0200X, 163WP1700X, 163WN0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP1700XNursing Service ProvidersRegistered NursePerinatal