Healthcare Provider Details

I. General information

NPI: 1437680915
Provider Name (Legal Business Name): MATTHEW TAIWO ABIOLA OGBEIDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10621 CHURCH ST STE 120
RANCHO CUCAMONGA CA
91730-6834
US

IV. Provider business mailing address

837 LAPWING RD
EDMOND OK
73003-4822
US

V. Phone/Fax

Practice location:
  • Phone: 909-944-0486
  • Fax:
Mailing address:
  • Phone: 405-916-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number162281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: