Healthcare Provider Details

I. General information

NPI: 1982418067
Provider Name (Legal Business Name): JENNIFER OGATA MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 SOLANO AVE
NAPA CA
94558-2232
US

IV. Provider business mailing address

7139 STONEBROOKE DR
VALLEJO CA
94591-8703
US

V. Phone/Fax

Practice location:
  • Phone: 707-304-5348
  • Fax:
Mailing address:
  • Phone: 707-548-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT20225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: