Healthcare Provider Details

I. General information

NPI: 1518128883
Provider Name (Legal Business Name): KISANI OGWARO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KISANI BERSBACH OGWARO M.D.

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 EL CAMINO REAL
SAN CARLOS CA
94070-5208
US

IV. Provider business mailing address

1692 EL CAMINO REAL TELECARE CORP/SAN MATEO TRANSITIONS
SAN CARLOS CA
94070-5208
US

V. Phone/Fax

Practice location:
  • Phone: 650-817-9070
  • Fax: 650-817-9074
Mailing address:
  • Phone: 650-817-9070
  • Fax: 650-817-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC163016
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number42542
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: