Healthcare Provider Details

I. General information

NPI: 1831854496
Provider Name (Legal Business Name): CHRISTINE OGBONNA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16185 LOS GATOS BLVD STE 205
LOS GATOS CA
95032-4569
US

IV. Provider business mailing address

4750 LINCOLN BLVD
MARINA DEL REY CA
90292-6900
US

V. Phone/Fax

Practice location:
  • Phone: 866-839-6979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: