Healthcare Provider Details

I. General information

NPI: 1407318355
Provider Name (Legal Business Name): PATRICIA OGUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S GROVE AVE # 7
ONTARIO CA
91761-4572
US

IV. Provider business mailing address

11660 CHURCH ST APT 570
RANCHO CUCAMONGA CA
91730-0502
US

V. Phone/Fax

Practice location:
  • Phone: 909-673-0099
  • Fax:
Mailing address:
  • Phone: 404-468-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number95028349
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number95028349
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1028197
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: