Healthcare Provider Details

I. General information

NPI: 1568669125
Provider Name (Legal Business Name): GERALDINE A OGANS CADCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W HENDERSON AVE
PORTERVILLE CA
93257-1732
US

IV. Provider business mailing address

641 W. OAKMONT AVENUE
PORTERVILLE CA
93257
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-8585
  • Fax: 559-791-0183
Mailing address:
  • Phone: 559-781-6219
  • Fax: 559-791-0183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberI8494705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: