Healthcare Provider Details

I. General information

NPI: 1750099313
Provider Name (Legal Business Name): DR. IKPONMWOSA CHRISTOPHER OGBEIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5869 61ST ST
SACRAMENTO CA
95824-3122
US

IV. Provider business mailing address

5869 61ST ST
SACRAMENTO CA
95824-3122
US

V. Phone/Fax

Practice location:
  • Phone: 707-704-1521
  • Fax:
Mailing address:
  • Phone: 707-704-1521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: