Healthcare Provider Details

I. General information

NPI: 1467074328
Provider Name (Legal Business Name): FRANCIS OKODOGBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 FULTON AVE
SACRAMENTO CA
95821-4909
US

IV. Provider business mailing address

6818 ELVORA WAY
ELK GROVE CA
95757-5910
US

V. Phone/Fax

Practice location:
  • Phone: 916-430-7104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95014272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: