Healthcare Provider Details

I. General information

NPI: 1578706404
Provider Name (Legal Business Name): AYESHA OGLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43322 GINGHAM AVE
LANCASTER CA
93535-4576
US

IV. Provider business mailing address

2318 W AVENUE P12
PALMDALE CA
93551-6021
US

V. Phone/Fax

Practice location:
  • Phone: 661-874-4050
  • Fax:
Mailing address:
  • Phone: 310-430-0190
  • Fax: 661-526-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95006530
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number650644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: