Healthcare Provider Details

I. General information

NPI: 1316494099
Provider Name (Legal Business Name): JOAN OGBUEHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 TRUXTUN AVE STE 100&110
BAKERSFIELD CA
93309-0679
US

IV. Provider business mailing address

6001 TRUXTUN AVE STE 100&110
BAKERSFIELD CA
93309-0679
US

V. Phone/Fax

Practice location:
  • Phone: 661-509-5901
  • Fax:
Mailing address:
  • Phone: 661-509-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: