Healthcare Provider Details

I. General information

NPI: 1902767957
Provider Name (Legal Business Name): EDWIN UFUOMA OYUBU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 MOSSY BANK DR APT 7
SACRAMENTO CA
95833-2354
US

IV. Provider business mailing address

2330 MOSSY BANK DR APT 7
SACRAMENTO CA
95833-2354
US

V. Phone/Fax

Practice location:
  • Phone: 916-877-1042
  • Fax:
Mailing address:
  • Phone: 916-877-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: