Doctor Name: | MR. ANTHONY OGBODO |
NPI Number: | 1063884625 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 95002864 |
Business Practice Address: | 4180 Cherry Blossom Ln Tracy, CA - 953778825 |
Business Phone Number: | 5107553004 |
Business Fax Number: | |
Mailing Address: | 4180 Cherry Blossom Ln, TRACY |
State: | CA |
Postal Code: | 953778825 |
Phone Number: | 5107553004 |
Fax Number: | |
NPI Enumeration Date: | 10/22/2015 |
NPI Last Update Date: | 10/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 95002864 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |