Healthcare Provider Details

I. General information

NPI: 1316688039
Provider Name (Legal Business Name): NOSAKHARE S OGIAMIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 ALTA ARDEN EXPY
SACRAMENTO CA
95825-2103
US

IV. Provider business mailing address

2075 W EL CAMINO AVE APT 590
SACRAMENTO CA
95833-1493
US

V. Phone/Fax

Practice location:
  • Phone: 916-481-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: