Healthcare Provider Details

I. General information

NPI: 1467159590
Provider Name (Legal Business Name): OGHOGHO UHUNMWANGHO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 WILLOW AVE STE 10
CLOVIS CA
93612-4715
US

IV. Provider business mailing address

4121 SCOTT AVE
CLOVIS CA
93619-5309
US

V. Phone/Fax

Practice location:
  • Phone: 831-208-4416
  • Fax: 559-593-7635
Mailing address:
  • Phone: 831-208-4416
  • Fax: 559-593-7635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023249
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberNP95023249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: