Healthcare Provider Details

I. General information

NPI: 1437164126
Provider Name (Legal Business Name): OGO EZEOKEKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 GRANT AVE SUITE 150
NOVATO CA
94945-7001
US

IV. Provider business mailing address

750 GRANT AVE SUITE 150
NOVATO CA
94945-7001
US

V. Phone/Fax

Practice location:
  • Phone: 415-899-9800
  • Fax: 415-899-9805
Mailing address:
  • Phone: 415-899-9800
  • Fax: 415-899-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number8750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: